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Volume 14, Number 9—September 2008
Dispatch
Diagnostic Challenges of Central Nervous System Tuberculosis
Laura J. Christie
, Ann M. Loeffler, Somayeh Honarmand, Jennifer M. Flood, Roger Baxter, Susan Jacobson, Rick Alexander, and Carol A. Glaser
, Ann M. Loeffler, Somayeh Honarmand, Jennifer M. Flood, Roger Baxter, Susan Jacobson, Rick Alexander, and Carol A. Glaser
Table
Comparison of TB encephalitis with viral encephalitis, California Encephalitis Project*
| Characteristic | CNS TB | HSV-1 | Enterovirus |
|---|---|---|---|
| Total no. cases |
20 |
39 |
44 |
| Patient demographics | |||
| Male, no. (%) | 12 (60) | 14 (36) | 25 (57) |
| Median age, y (range) | 41 (8 mo–77y) | 55 (8 mo–89 y) | 13 (6 mo–74 y)† |
| Race white, non-Hispanic, no. (%) |
3 (15) |
22 (69)‡ |
14 (33) |
| Clinical data | |||
| Interval from CNS onset to admission, d, median (range) | 5 (0–62) | 2 (0–28) | 2 (0–18)† |
| ICU care, no (%) | 15 (75) | 19 (56) | 20 (53) |
| Fever, no. (%) | 15 (75) | 35 (92) | 35 (80) |
| Seizures, no. (%) | 7 (35) | 22 (58) | 12 (27) |
| Altered consciousness, no. (%) | 13 (65) | 30 (79) | 20 (50) |
| Personality change, no. (%) | 9 (45) | 17 (45) | 7 (17)† |
| Hallucinations, no. (%) | 3 (16) | 7 (21) | 3 (7) |
| Stiff neck, no. (%) | 14 (70) | 12 (32)§ | 19 (44) |
| Ataxia, no. (%) | 7 (37) | 6 (23) | 11 (28) |
| Length of hospital stay, d, median (range) |
30 (8–753) |
15 (0–738)§ |
6 (0–1,124)¶ |
| Laboratory results | |||
| CSF leukocytes, per mL, median (range) | 201 (42–2,845) | 47 (0–975)‡ | 85 (0–1,080)† |
| CSF protein, mg/dL, median (range) | 174 (66–357) | 71 (15–297)‡ | 60 (19–881)¶ |
| CSF glucose, mg/dL, median (range) |
35 (9–132) |
69 (39–112)‡ |
67 (38–159)¶ |
| MRI/CT (abnormal, initial study), no. (%) |
17 (85) |
36 (95) |
12 (39)¶ |
| Inpatient deaths, no. (%) | 6 (30) | 8 (21) | 4 (9)† |
*CNS, central nervous system; TB, tuberculosis (Mycobacterium tuberculosis); HSV-1, herpes simplex virus 1; ICU, intensive care unit; CSF, cerebrospinal fluid; MRI, magnetic resonance imaging; CT, computed tomography. Denominators may vary slightly depending on available data. Data were analyzed (2-way analysis) by using Fisher exact test, χ2 test, or Kruskal-Wallis test as appropriate, with statistical significance set at α = 0.05. Comparisons without a symbol did not reach statistical significance.
†CNS TB vs. enterovirus, p<0.05.
‡CNS TB vs. HSV-1, p<0.001.
§CNS TB vs. HSV-1, p<0.05.
¶CNS TB vs. enterovirus, p<0.001.
- Page created: July 13, 2010
- Page last updated: July 13, 2010
- Page last reviewed: July 13, 2010
- Centers for Disease Control and Prevention,
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National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)
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