Tuberculous Meningitis-Mimicking Varicella-Zoster Meningitis
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Background: Varicella-zoster virus (VZV) is one of the most common etiologies of aseptic meningitis. The severest manifestation of VZV meningitis is occasionally confused with tuberculous meningitis (TBM). Thus, we investigated the clinical manifestations of VZV meningitis as compared with those of TBM. Materials and Methods: All adult patients who were diagnosed with VZV meningitis or TBM were enrolled at a tertiary hospital in Seoul, South Korea, during an 8-year period. The clinical characteristics and cerebrospinal fluid (CSF) profile of patients were analyzed. Results: Seventy-nine patients with VZV meningitis and 24 patients with TBM were enrolled in this study. Of the 79 patients with VZV meningitis, 63 (80%) did not received empirical anti-tuberculous therapy (Group 1) and the remaining 16 (20%) received empirical anti-tuberculous therapy (Group 2), compared with 24 patients with TBM (Group 3). Altered mental status, intensive care unit (ICU) admission, neurologic sequelae, CSF protein levels, and CSF adenosine deaminase levels revealed a trend of being higher in Group 3 than Group 2, which was higher than Group 1. However, the CSF/serum glucose ratio was significantly lower in Group 3 than in Group 1 or Group 2. Conclusion: About one fifth of VZV meningitis cases presented as severe manifestations, mimicking TBM. The CSF/serum glucose ratio might be useful to differentiate VZV meningitis from TBM until definite diagnostic tests are available. Physicians should keep in mind that a differential diagnosis between severe VZV meningitis and TBM is needed.
Abstract
Background: Varicella-zoster virus (VZV) is one of the most common etiologies of aseptic meningitis. The severest manifestation of VZV meningitis is occasionally confused with tuberculous meningitis (TBM). Thus, we investigated the clinical manifestations of VZV meningitis as compared with those of TBM. Materials and Methods: All adult patients who were diagnosed with VZV meningitis or TBM were enrolled at a tertiary hospital in Seoul, South Korea, during an 8-year period. The clinical characteristics and cerebrospinal fluid (CSF) profile of patients were analyzed. Results: Seventy-nine patients with VZV meningitis and 24 patients with TBM were enrolled in this study. Of the 79 patients with VZV meningitis, 63 (80%) did not received empirical anti-tuberculous therapy (Group 1) and the remaining 16 (20%) received empirical anti-tuberculous therapy (Group 2), compared with 24 patients with TBM (Group 3). Altered mental status, intensive care unit (ICU) admission, neurologic sequelae, CSF protein levels, and CSF adenosine deaminase levels revealed a trend of being higher in Group 3 than Group 2, which was higher than Group 1. However, the CSF/serum glucose ratio was significantly lower in Group 3 than in Group 1 or Group 2. Conclusion: About one fifth of VZV meningitis cases presented as severe manifestations, mimicking TBM. The CSF/serum glucose ratio might be useful to differentiate VZV meningitis from TBM until definite diagnostic tests are available. Physicians should keep in mind that a differential diagnosis between severe VZV meningitis and TBM is needed.
참고문헌 (22)
- Grahn A, "Varicella-zoster virus infections of the central nervous system – prognosis, diagnostics and treatment", J Infect, 71, pp.281~293 (2015)
- 이정은, "A Case of Transverse Myelitis Caused by Varicella Zoster Virus in an Immunocompetent Older Patient", Infection and Chemotherapy, 48(4), pp.334~337 (2016), 대한감염학회
- Ihekwaba UK, "Clinical features of viral meningitis in adults: significant differences in cerebrospinal fluid findings among herpes simplex virus, varicella zoster virus, and enterovirus infections", Clin Infect Dis, 47, pp.783~789 (2008)
- Glaser CA, "California Encephalitis Project, 1998-2000. In search of encephalitis etiologies: diagnostic challenges in the California Encephalitis Project, 1998-2000", Clin Infect Dis, 36, pp.731~742 (2003)
- Persson A, "Varicella-zoster virus CNS disease--viral load, clinical manifestations and sequels", J Clin Virol, 46, pp.249~253 (2009)
- Kim SH, "Rapid diagnosis of tuberculous meningitis by T cell-based assays on peripheral blood and cerebrospinal fluid mononuclear cells", Clin Infect Dis, 50, pp.1349~1358 (2010)
- 이유미, "Indeterminate T-SPOT.TB Test Results in Patients with Suspected Extrapulmonary Tuberculosis in Routine Clinical Practice", Infection and Chemotherapy, 45(1), pp.44~50 (2013), 대한감염학회[DOI]
- Tuon FF, "Adenosine deaminase and tuberculous meningitis--a systematic review with meta- analysis", Scand J Infect Dis, 42, pp.198~207 (2010)
- Park KH, "Diagnostic usefulness of T-cell based assays for tuberculous meningitis in HIV-uninfected patients", J Infect, 72, pp.486~497 (2016)
- Thwaites G, "Tuberculous meningitis", J Neurol Neurosurg Psychiatry, 68, pp.289~299 (2000)
- Thwaites GE, "Comparison of conventional bacteriology with nucleic acid amplification (amplified mycobacterium direct test) for diagnosis of tuberculous meningitis before and after inception of antituberculosis chemotherapy", J Clin Microbiol, 42, pp.996~1002 (2004)
- Shankar P, "Rapid diagnosis of tuberculous meningitis by polymerase chain reaction", Lancet, 337, pp.5~7 (1991)
- Miörner H, "Diagnosis of tuberculous meningitis: a comparative analysis of 3 immunoassays, an immune complex assay and the polymerase chain reaction", Tuber Lung Dis, 76, pp.381~386 (1995)
- Bonington A, "Use of Roche AMPLICOR Mycobacterium tuberculosis PCR in early diagnosis of tuberculous meningitis", J Clin Microbiol, 36, pp.1251~1254 (1998)
- Dora JM, "Polymerase chain reaction as a useful and simple tool for rapid diagnosis of tuberculous meningitis in a Brazilian tertiary care hospital", Braz J Infect Dis, 12, pp.245~247 (2008)
- Huang HJ, "rpoB nested PCR and sequencing for the early diagnosis of tuberculous meningitis and rifampicin resistance", Int J Tuberc Lung Dis, 13, pp.749~754 (2009)
- Lakeman FD, "Diagnosis of herpes simplex encephalitis: application of polymerase chain reaction to cerebrospinal fluid from brain-biopsied patients and correlation with disease", J Infect Dis, 171, pp.857~863 (1995), National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group
- Boivin G, "Diagnosis of herpesvirus infections of the central nervous system", Herpes, 11(Suppl 2), pp.48A~56A (2004)
- Xu HB, "Diagnostic value of adenosine deaminase in cerebrospinal fluid for tuberculous meningitis: a meta-analysis", Int J Tuberc Lung Dis, 14, pp.1382~1387 (2010)
- Choi SH, "The possible role of cerebrospinal fluid adenosine deaminase activity in the diagnosis of tuberculous meningitis in adults", Clin Neurol Neurosurg, 104, pp.10~15 (2002)
- Moghtaderi A, "Comparative analysis of cerebrospinal fluid adenosine deaminase in tuberculous and non-tuberculous meningitis", Clin Neurol Neurosurg, 112, pp.459~462 (2010)
- Rana SV, "To compare CSF adenosine deaminase levels and CSF-PCR for tuberculous meningitis", Clin Neurol Neurosurg, 112, pp.424~430 (2010)