Rare Tubercular Meningitis Presenting as Neutrophilic Meningitis
Journal name: The Malaysian Journal of Medical Sciences
Original article title: A Rare Presentation of Tubercular Meningitis as Persistent Neutrophilic Meningitis
The Malaysian Journal of Medical Sciences (MJMS) is a peer-reviewed, open-access journal published online at least six times a year. It covers all aspects of medical sciences and prioritizes high-quality research.
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Tarun Ralot, Chander Bafna, Surender Singh, Shubhkaran Sharma
The Malaysian Journal of Medical Sciences:
(A peer-reviewed, open-access journal)
Full text available for: A Rare Presentation of Tubercular Meningitis as Persistent Neutrophilic Meningitis
Year: 2017 | Doi: 10.21315/mjms2017.24.6.13
Copyright (license): CC BY 4.0
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Summary of article contents:
Introduction
Persistent neutrophilic meningitis is a rare form of chronic meningitis characterized by the presence of neutrophils in cerebrospinal fluid (CSF) for more than one week despite adequate antimicrobial therapy. This condition often presents a diagnostic challenge, as typical tubercular meningitis usually manifests with lymphocytic pleocytosis. The presented case describes an immunocompetent 25-year-old man diagnosed with tubercular meningitis (TBM), who exhibited signs of persistent neutrophilic meningitis, which is an uncommon presentation for TBM. The case emphasizes the need for careful evaluation in similar clinical situations, given the high prevalence of tuberculosis in certain regions.
Importance of Clinical and Radiological Findings
The case study demonstrates that, while neutrophilic pleocytosis is a common initial finding in certain infections, its persistence beyond one week, coupled with negative cultures for common pathogens, suggests a potential underlying condition such as TBM. In the featured case, the patient, initially treated for bacterial meningitis, was later evaluated through MRI, which revealed granulomas indicative of TB. Although CSF analysis initially showed elevated neutrophils, subsequent analyses confirmed the absence of common bacterial and viral pathogens, reinforcing the diagnosis of TBM. The patient's treatment with anti-tubercular therapy led to gradual improvement, thereby highlighting the importance of early recognition and treatment based on clinical suspicion and supportive imaging findings.
Conclusion
The report concludes that persistent neutrophilic pleocytosis can occasionally be indicative of tubercular meningitis, even after an extended duration, necessitating prompt initiation of anti-tubercular treatment based on clinical and radiological evidence. This case underlines the complexity of diagnosing meningitis, particularly in regions where tuberculosis is endemic, and the importance of employing comprehensive evaluation strategies. Further clinical research is warranted to explore such rare presentations and improve understanding of their underlying mechanisms.
FAQ section (important questions/answers):
What is persistent neutrophilic meningitis and how is it defined?
Persistent neutrophilic meningitis is a rare type of chronic meningitis characterized by neutrophilic pleocytosis in cerebrospinal fluid (CSF) that lasts longer than a week, even after starting empirical antimicrobial treatment.
How does tubercular meningitis typically present in cerebrospinal fluid analysis?
Tubercular meningitis usually shows lymphocytic pleocytosis in CSF. Initially, it may present with neutrophilic pleocytosis, but this does not typically persist for more than a week.
What was the treatment and outcome for the patient with TBM?
The patient, a 25-year-old male, received anti-tubercular treatment based on MRI findings. Despite persistent neutrophils in CSF, he showed clinical improvement and fully recovered after completing a year-long treatment.
What makes the case of persistent neutrophilic meningitis in TBM unique?
This case is notable because it is one of the rare instances where tubercular meningitis presented as persistent neutrophilic meningitis, defying typical patterns of CSF analysis.
Glossary definitions and references:
Scientific and Ayurvedic Glossary list for “Rare Tubercular Meningitis Presenting as Neutrophilic Meningitis”. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.
1) Table:
In medical literature, a 'Table' is a structured way to present data and findings. It allows for a concise summary of important quantitative information such as laboratory results, parameters, or patient demographics. Tables facilitate easy comparison and quick reference, enhancing the clarity and utility of research findings for readers in academic and clinical settings.
2) Disease:
'Disease' refers to a pathological condition of a biological system leading to abnormal functioning. In this context, diseases like meningitis can have serious implications for health, particularly when caused by infections such as tuberculosis. Understanding diseases enables healthcare professionals to diagnose and treat effectively, aiming to improve patient outcomes.
3) Tuberculosis:
'Tuberculosis' (TB) is an infectious disease primarily caused by the bacterium Mycobacterium tuberculosis. It predominantly affects the lungs but can impact other parts of the body. TB remains a significant health threat globally, particularly in regions with high prevalence. Its complexity necessitates effective diagnostic practices and comprehensive treatment regimens.
4) Medicine:
'Medicine' encompasses the science and practice of diagnosing, treating, and preventing diseases. It integrates various fields, including pharmacology, surgery, and public health, to improve health outcomes. Advancements in medicine have led to better disease management, particularly for infectious diseases like tuberculosis, highlighting its importance in global health.
5) Peacock:
'Peacock' refers to a significant figure in medical literature, specifically in the context of chronic neutrophilic meningitis. His contributions have shaped the understanding of disease manifestations and treatment approaches. Works authored by Peacock have been influential, providing insights that guide current medical practices and clinical decision-making.
6) Sugar:
'Sugar' in this context refers to glucose levels measured in cerebrospinal fluid (CSF), a critical laboratory parameter in diagnosing meningitis. Abnormal glucose levels can distinguish between types of meningitis, such as bacterial versus viral. Monitoring glucose levels aids in assessing disease severity and guiding appropriate treatment interventions.
7) Science (Scientific):
'Scientific' involves systematic methodologies rooted in empirical evidence and research. In medicine, a scientific approach is vital for developing effective treatments, understanding disease mechanisms, and conducting clinical trials. It underscores the importance of evidence-based practices in advancing healthcare quality and ensuring reliable medical knowledge.
8) Account:
'Account' here relates to the reporting and documentation of medical findings and observations. Accuracy in an account allows healthcare professionals to track patient progress, understand disease dynamics, and formulate management plans. Detailed accounts in medical literature contribute to the collective knowledge, aiding research and clinical practices.
9) Indian:
'Indian' refers to the geographic context of a significant burden of tuberculosis. The Indian population experiences a high incidence of TB, necessitating focused public health strategies. Understanding cultural and societal factors in India is crucial for effective prevention, diagnosis, and treatment of this persisting health issue.
10) Mason:
'Mason' signifies a contributor recognized within medical literature. Specific references may pertain to studies or findings that enhance understanding of diseases. Contributions from authors like Mason play a vital role in advancing knowledge regarding diagnostic criteria and treatment protocols, influencing clinical practice and improving patient care.
11) Edema (Oedema):
'Edema' refers to swelling caused by excess fluid accumulation in tissues. In cases of meningitis, edema can exacerbate neurological symptoms and complicate recovery. Recognizing and managing edema is vital for patient comfort and recovery, as it may indicate underlying inflammatory processes or complications requiring timely intervention.
12) Fever:
'Fever' is a common clinical symptom reflecting an inflammatory response to infection. In meningitis cases, persistent fever may indicate active disease and the need for prompt treatment. Understanding fever patterns helps clinicians assess disease severity, monitor treatment response, and adjust therapeutic strategies accordingly.
13) Blood:
'Blood' plays a crucial role in diagnosing various conditions, serving as a medium for numerous biological markers. In the context of infections and diseases, blood tests provide invaluable information regarding immune response and metabolic status. Effective blood analysis contributes significantly to accurate diagnoses and timely interventions in clinical practice.
14) Post:
'Post' can refer to post-treatment phases in a medical context. Monitoring patients after treatment for conditions like meningitis is crucial to assess recovery and identify potential relapse. This follow-up allows healthcare providers to evaluate the effectiveness of therapies and make necessary adjustments for patient care.
15) Drug:
'Drug' signifies pharmaceuticals used in treating infections and diseases. In the context of tuberculosis, the choice of drugs is critical for effective treatment. Understanding the pharmacology, mechanisms of action, and potential side effects of drugs contributes to developing effective treatment regimens and improving patient outcomes.
16) Viru:
'Viru' may refer to 'virus' in a medical context. While discussing meningitis, it is essential to differentiate between viral and bacterial causes, as treatment approaches differ significantly. Understanding viral infectious agents is critical for establishing fatigue, prophylaxis protocols, and guiding treatment options for specific infections.
17) Chan:
'Chan' refers to a contributor in the medical literature relevant to conditions like tuberculosis and its management. The works of contributors such as Chan provide critical perspectives and evidence-based recommendations, informing best practices in diagnosis and treatment, thus benefiting patient care in various settings.
18) Inflammation:
'Inflammation' is a biological response to harmful stimuli, including pathogens, characterized by redness, swelling, and heat. In meningitis, inflammation of the meninges can lead to significant complications. Understanding inflammation mechanisms aids clinicians in formulating treatment options to manage symptoms effectively and prevent disease progression.
19) Discussion:
'Discussion' in a medical article presents interpretations of findings and implications for clinical practice. It allows authors to contextualize their results within existing literature, offering insights that can advance understanding and management of diseases. A robust discussion is central to translating research into practical guidelines and applications.
20) Knowledge:
'Knowledge' is fundamental to healthcare, underpinning all clinical decision-making. Expanding knowledge through research, education, and practice is essential for improving healthcare outcomes. In fields like infectious disease management, ongoing knowledge development enhances understanding of pathophysiology, diagnostics, and effective therapeutic options, contributing to better patient care.
21) Vomiting:
'Vomiting' is a common symptom associated with various health conditions, including infections like meningitis. It often signifies systemic involvement and requires comprehensive assessment. Understanding the underlying causes and managing symptoms are important in clinical practice to ensure the comfort and recovery of affected patients.
22) Activity:
'Activity' in a medical context refers to the functioning and responsiveness of biological systems. In assessing patients, particularly during illness, monitoring activity levels can provide insights into overall health status. Low activity may indicate severe disease progression requiring timely intervention for better clinical outcomes.
23) India:
'India' is significant in the context of tuberculosis prevalence and public health challenges. Addressing TB within the Indian healthcare context requires understanding regional health policies, socioeconomic factors, and community health initiatives. National awareness campaigns are crucial for effective tuberculosis management and reducing the disease burden.
24) Rules:
'Rules' pertain to the established guidelines and protocols in clinical practice. In managing diseases, adhering to rules ensures consistency and quality in diagnosis, treatment, and patient care. Understanding and following these rules is crucial in optimizing health outcomes and improving the overall efficacy of health systems.
25) Sign:
'Sign' refers to observable indicators of disease that healthcare providers use to evaluate patient health. Recognizing signs in clinical presentations aids in diagnosing conditions like meningitis and forming treatment plans. A thorough understanding of clinical signs is essential for effective patient assessment and timely interventions.
Other Science Concepts:
Discover the significance of concepts within the article: ‘Rare Tubercular Meningitis Presenting as Neutrophilic Meningitis’. Further sources in the context of Science might help you critically compare this page with similair documents:
Tuberculosis, Meningitis, Viral Infection, Blood sugar, TLC, Antimicrobial therapy, Fungal infection, Magnetic resonance imaging, Computed tomography scan, MRI brain, Cerebrospinal Fluid, Total leucocyte count, Clinical suspicion, Socioeconomic impact, Low grade fever, Herpes Simplex Virus, Bacterial pathogen, Anti-tubercular therapy, Vasogenic edema, Total cell count, Anti-tubercular treatment, High morbidity, Bacterial meningitis, Acid-fast bacilli, Cerebrospinal fluid analysis, CSF analysis, CSF culture, Meningitis symptoms, Neutrophilic pleocytosis, Anti-epileptic drug, Central nervous system tuberculosis, Treatment initiation, Chronic meningitis, Ring enhancing lesion, Inflammatory granuloma, Granuloma.