Importance of CSF Glucose: Protein Ratio in Diagnosis of Tuberculous Meningitis

Background: Tuberculous meningitis (TBM) is the most severe manifestation of extrapulmonary tuberculosis with a high mortality and morbidity rates. As per the global tuberculosis (TB) report of 2017, the estimated incidence of TB in India was approximately 2,800,000 accounting for about a quarter of the world's TB cases. Many a times differentiating tuberculous meningitis from pyogenic meningitis becomes very difficult. The diagnosis depends upon clinical manifestation and cytochemical analysis of cerebrospinal fluid (CSF). Many researchers found that the CSF glucose: protein ratio less than 0.5 is useful to differentiate tubercular disease from non-tubercular meningitis.

Methods: A total of Sixty-two patients admitted to this tertiary hospital with symptoms and signs of meningitis, were selected and divided into two groups: tubercular (n=39) and pyogenic (n=23), depending upon the accepted criteria. Clinical features and CSF parameters noted in each patient.

Results: The mean age of patients with tubercular meningitis was 39.07 ± 16.67 years and that of pyogenic meningitis 34.35 ± 16.73 years. On CSF cytological and biochemical analysis the mean total white blood cell count was 256.74 ± 184.03 /cmm, mean protein 182.22 ± 113.12 mg/ dl and mean sugar 52.85 ± 19.3 in TBM whereas in pyogenic meningitis 106.17± 185.18/cmm, 88.78 ±114.35 mg/ dl, and 63.47 ±19.48 mg/ dl  respectively. The CSF glucose: protein ratio in TBM was 0.29 and 0.71 in pyogenic meningitis.

Conclusion:  It was found that the CSF glucose: protein ratio of ≤ 0.5 may be useful in differentiating tuberculous from pyogenic meningitis high sensitivity and specificity. The cutoff value is highly statistically significant.


Munish Kumar

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