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Trop Doct 2009;39:76-78
doi:10.1258/td.2008.080242
© 2009 Royal Society of Medicine Press

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Articles

Atypical cerebrospinal fluid profile in tuberculous meningitis

Vitor Laerte Pinto, Jr *    Marco Antonio Lima *   Valéria Cavalcanti Rolla *   Maria Cristina Rebelo {dagger}   Marcio Neves Bóia {ddagger}

* Evandro Chagas Clinical Research Institute, Oswaldo Cruz Foundation, Av. Brasil 4365, Manguinhos 21040-360, Rio de Janeiro; {dagger} Meningitis Reference Laboratory, São Sebastião Infectious Disease State Institute, Rio de Janeiro; {ddagger} Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil

Correspondence to: Vitor Laerte Pinto Jr, Evandro Chagas Clinical Research Institute, Oswaldo Cruz Foundation, Av. Brasil 4365, Manguinhos 21040-360, Rio de Janeiro, Brazil Email: vitor.laerte{at}ipec.fiocruz.br

The aim of this study was to describe atypical cerebrospinal fluid (CSF) alterations in tuberculous meningitis (TBM) and to analyse the differences in outcome between patients with typical and atypical profiles. We did a retrospective study during the period of 2000 to 2005 including the cases of TBM assisted in a referral centre for infectious diseases in Rio de Janeiro State, Brazil. Neutrophilic plecytosis at the first spinal tap was found in 32.4% of TBM patients, who had a worse outcome when compared with those patients with typical CSF profiles. One factor that might have a major impact was the delay in starting empirical treatment (27.5 versus 11.6 days). We conclude that, in cases with clinical and epidemiological data compatible with TBM but with an atypical CSF profile, empirical treatment should be considered if CSF culture and direct examination for bacteria are negative.


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