LABORATORY

EXAMINATION FOR
TUBERCULOUS MENINGITIS
Deomampo, John Louis

INITIAL LABORATORY EXAMS

Complete blood count and Leukocyte Differential
Serum electrolytes
Urinalysis
Chest X-ray

Complete blood count and Leukocyte Differential

Test used to evaluate your overall health and detect a wide range of disorders,
including anemia, infection and leukemia
Most common hematologic findings
are mild anemia, leukocytosis, and
thrombocytosis
with
a
slightly
elevated erythrocyte sedimentation
rate and/or C-reactive protein level.
None of these findings is consistent
or
sufficiently
accurate
for
diagnostic purposes.

Complete blood count and Leukocyte Differential

TB results in Leukocytosis with the predominance of Lymphocytes

Serum electrolytes

A manifestation of TB is hyponatremia due to the syndrome of

inappropriate secretion of antidiuretic hormone has also been
reported.

Urinalysis
Urinalysisis a test that evaluates a sample of your
urine.
Itis used to detect and assess a wide range of
disorders, such as urinary tract infection, kidney disease
and diabetes.

To assess the spread of infection

To rule out /rule in Genitourinary TB

Chest X-ray
An X-ray is an imaging test
that uses small amounts of
radiation to produce pictures
of the organs, tissues, and
bones of the body.
To assess the condition of the
patients lungs
To determine what is causing
the hemoptysis of the patient

Specific tests for Tuberculosis

Acid fast bacteria Staining
Specimen culture

Specific tests for Tuberculosis

Acid fast bacteria Staining

Specific tests for Tuberculosis

Acid fast bacteria Staining

Specific tests for Tuberculosis

Specimen Culture

LABORATORY EXAMINATION FOR

TUBERCULOUS MENINGITIS
The rapid diagnosis of TB Meningitis is fundamental for clinical outcome.
The diagnosis of tuberculous meningitis can be difficult early in its course,
requiring a high degree of suspicion on the part of the clinician.
The diagnosis cannot be made by or excluded on clinical grounds but a history
of recent TB contact and the presence of extrameningeal TB is helpful.
Current laboratory methods are insensitive and slow.
Newer methods such as those involving the amplification of bacterial DNA by
the polymerase chain reaction (PCR) and comparable systems are
incompletely assessed, and are not suitable for widespread use in the
developing world.
The careful and repeated search for acid fast bacilli with Ziehl-Neelsen staining
is still one of the most effective rapid diagnostic tests.
The most important laboratory test for the diagnosis of tuberculous meningitis
is examination and culture of the lumbar CSF.

LABORATORY EXAMINATION FOR

TUBERCULOUS MENINGITIS
CSF examination
AFB microscopy
Mycobacterial Culture and drug susceptibility
Neuroimaging tests
Tuberculin skin testing
Interferon gamma assays
Nucleic acid amplifications
Serologic tests

CSF EXAMINATION
Lumbar puncture is the cornerstone of diagnosis.

CSF EXAMINATION
CSF leukocyte count:
high leukocyte count (up to 1000/L)
Usually, with a predominance of lymphocytes
Sometimes, predominance of neutrophils in the early stage

CSF glucose:
Low glucose concentration
typically <40 mg/dL but rarely <20 mg/dL.

Protein:
elevated and may be markedly high secondary to hydrocephalus and spinal block.
protein content of 18 g/L (100800 mg/dL)

*However, any of these three parameters can be within the normal range.

AFB MICROSOPY
AFB are seen on direct smear of CSF sediment in up to
one-third of cases, but repeated lumbar punctures
increase the yield.
Examinations or culture of small amounts of CSF are
unlikely to demonstrate M. tuberculosis.
When 5-10 mL of lumbar CSF can be obtained, the acid-fast
stain of the CSF sediment is positive in up to 30% of cases and
the culture is positive in 50-70% of cases.

A presumptive diagnosis is commonly based on the

finding of AFB on microscopic examination of a
diagnostic specimen.

 Methods:
Traditional:
Light microscopy of specimens stained with Ziehl-Neelsen
basic fuschin dyes
-nevertheless satisfactory but time consuming

Modern:
Auramine-rhodamine staining and fluorescence microscopy
-Process large numbers of diagnostic Specimens

Light-emitting diode (LED) fluorescence microscopes

-Less expensive

MYCOBACTERIUM CULTURE AND

SUSCEPTIBILITY
The culture of M. tuberculosis from the CSF is the gold
standard for diagnosis, but is insensitive and slow.
Culture of CSF is diagnostic in up to 80% of cases.

Specimens are inoculated onto

egg or agar based medium,
(Lwenstein-Jensen or
Middlebrook 7H10)
incubated at 37C (under 5% CO
2 for Middlebrook medium)
48 weeks may be required
before growth is detected

 *Although M. tuberculosis may be identified

presumptively on the basis of growth time and colony
pigmentation and morphology, a variety of biochemical
tests have traditionally been used to speciate
mycobacterial isolates.

There are new methods that have decreased the

time required for bacteriologic confirmation of TB
to 23 weeks:
Use of liquid culture for isolation and species identification by
molecular methods or high-pressure liquid chromatography of
mycolic acids
replaced isolation on solid media and identification by biochemical tests.

Immunochromatographic lateral flow assay

low-cost, rapid and it is based on detection of MTP64 antigen may also be
used for species identification of M. tuberculosis complex in culture isolates

Drug susceptibility test are done to determine the best

therapeutic regimen
The initial isolate of M. tuberculosis should be tested for susceptibility
to isoniazid and rifampin to detect MDR-TB, particularly if one or more
risk factors for drug resistance are identified or the patient either fails
to respond to initial therapy or has a relapse after the completion of
treatment.
Expanded susceptibility testing for second-line anti-TB drugs
mandatory when MDR-TB is found.
Susceptibility testing may be conducted directly (with the clinical
specimen) or indirectly (with mycobacterial cultures) on solid or liquid
medium.

IMAGING STUDIES
Radiographic studies can aid in the diagnosis of
tuberculous meningitis.
The advent of CT and MRI has provided insight into
disease progression, and gives prognostic and
diagnostic information.
Both CT and MRI are sensitive to the changes of TBM,
particularly hydrocephalus and basal meningeal
exudates, but they lack specificity.
MRI may provide more diagnostic information than CT
when assessing space occupying lesions.

 Early stages:
May be normal

As the disease progresses:

Basilar enhancement and communicating hydrocephalus with
signs of cerebral edema or early focal ischemia are the most
common findings.
Abnormal enhancement of basal cisterns or ependymal can
also be seen

 Hydrocephalus
greater in the young, and increases with duration of the illness.

Tuberculoma

manifestation of CNS tuberculosis

tumor-like mass resulting from aggregation of caseous tubercles that usually manifests
clinically as a brain tumor.
In adults tuberculomas are most often supratentorial, but in children they are often
infratentorial, located at the base of the brain near the cerebellum
The most common symptoms are headache, fever, focal neurologic findings, and convulsions.
CT or MRI reveals contrast enhanced ring lesions, but biopsy is necessary to establish the
diagnosis. However, surgical removal is not necessary because most tuberculomas resolve
with medical management.
This phenomenon should be considered whenever a child with tuberculous meningitis
deteriorates or develops focal neurologic findings while on treatment.

Other tests to consider:

HIV test