OSPE tuberculous meningitis Flashcards
case
fever, disorientation, projectile vomiting and seizures. On examination, Kernig’s sign and Brudzinski sign were positive.
CSF
- CSF pressure increased, glucose slightly reduced, protein greatly increased, lymphocytosis ++ with cobweb coagulum : Suggestive of tuberculous meningitis ( Age group also significant)
further test to be performed on the CSF sample.
CSF Ziehl-Neelsen (Acid fast) staining
What other tests and body samples would you collect for further investigations?
- Culture on LJ medium followed by biochemical tests and drug resistance tests
- Immunological test – Antigen detection
- Molecular tests: PCR
- Other samples: Blood for serology
- Skin test : Mantoux test for Type IV hypersensitivity
- CT scan of brain
Identify the staining procedure
Ziehl Neelsen staining / Acid fast staining
Describe the microscopic findings
Pink acid fast bacilli seen against a blue background
State the special culture media used to isolate the causative agent
Lowenstein Jensen Medium
Describe the colony morphology of the isolate on the special media
Rough, tough , buff-colored colonies
Identify the special stain used.
Auramine O stain- fluorescent bacilli seen
State the causative organism
Mycobacterium tuberculosis
List the further tests which are useful to confirm the causative organism
Automated culture, biochemical tests ( Niacin and catalase tests), Interferon gamma assay, Luciferase assay, Line probe assay, GeneXpert
Which other sample would be useful in diagnosis of the suspected condition?
- Serum: Immunoassay
- CT scan brain: Brain stem lesion common , Thick fibrinous exudate in basal cistern, hydrocephalus
State the treatment regimen for this condition.
ATT : INH, Rifampicin, Streptomycin, Pyrazinamide→ Intensive + Maintenance therapy
What is the importance of testing for drug resistance in this condition?
To rule out MDR –TB and change the treatment regimen if required
Sample collected :
Cerebrospinal fluid (CSF) * Blood
