Chronic Meningitis in Thailand

Vol. 26, No. 1, 2006

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Original Paper

Chronic Meningitis in Thailand
Clinical Characteristics, Laboratory Data and Outcome in Patients with Specific Reference to Tuberculosis and Cryptococcosis
R. Helbok^{a, b}, S. Pongpakdee^b, S. Yenjun^b, W. Dent^a, R. Beer^a, P. Lackner^a, P. Bunyaratvej^b, B. Prasert^b, A. Vejjajiva^b, E. Schmutzhard^a

^aClinical Department of Neurology, Medical University Innsbruck, Innsbruck, Austria;
^bFaculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

Address of Corresponding Author

Neuroepidemiology 2006;26:37-44 (DOI: 10.1159/000089236)

Key Words

Chronic meningitis
Tuberculous meningitis
Cryptococcal meningitis
HIV

Abstract

The charts of 114 consecutive patients with chronic meningitis admitted to a general hospital in Bangkok, Thailand, between 1993 and 1999 were retrospectively reviewed. The most common causative agents were Cryptococcus neoformans (54%) and Mycobacterium tuberculosis (37%). HIV and other underlying diseases had a major impact on the presentation of chronic cryptococcal meningitis patients. Compared to HIV-negative cryptococcal meningitis patients (21%), HIV-positives (79%) had a significantly lower incidence of focal signs (p = 0.02), hydrocephalus (p = 0.03) and seizures (p = 0.001) during hospital stay, furthermore, a lower leucocyte level, a significantly higher glucose level (p = 0.02) and a lower protein level (p = 0.03) in the first cerebrospinal fluid examination. Of the 43 patients with chronic tuberculous meningitis, only 3 were HIV positive. Focal neurologic deficits were found more frequently in tuberculous meningitis patients (p = 0.001) when compared to cryptococcal meningitis patients without HIV. Cerebral infarction on cerebral CT was indicative of tuberculous meningitis. Cryptococcal meningitis patients with HIV infection had a worse outcome compared to non-AIDS patients. Advanced stage of the disease on admission, decreased level of consciousness prior to and on the admission day and raised intracranial pressure above 40 cm H₂O at any given time were predictive of a poor outcome in tuberculous meningitis patients.

Author Contacts

Raimund Helbok, MD, DTM&H, MCTM
Department of Neurology, Medical University Innsbruck
Anichstrasse 35
AT-6020 Innsbruck (Austria)
Fax +43 512 504 4243, E-Mail raimund.helbok@uklibk.ac.at

Article Information

Published online: October 25, 2005
Number of Print Pages : 8
Number of Figures : 2, Number of Tables : 3, Number of References : 21

Medline Abstract (ID 16254452)

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