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The value of repeat lumbar cerebrospinal fluid analysis in the diagnosis of childhood TBM
Thesis (MMed)--Stellenbosch University, 2019.
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| Format: | Thesis |
| Language: | en_ZA |
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Stellenbosch : Stellenbosch University
2019
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| _version_ | 1867613741593395200 |
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| access_status_str | Open Access |
| author | Grobbelaar, Madelein |
| author2 | Solomons, Regan |
| author_browse | Grobbelaar, Madelein Solomons, Regan |
| author_facet | Solomons, Regan Grobbelaar, Madelein |
| author_sort | Grobbelaar, Madelein |
| collection | Thesis |
| dc_rights_str_mv | Stellenbosch University |
| description | Thesis (MMed)--Stellenbosch University, 2019. |
| format | Thesis |
| id | oai:scholar.sun.ac.za:10019.1/106955 |
| institution | Stellenbosch University (South Africa) |
| language | en_ZA |
| last_indexed | 2026-06-10T12:40:58.109Z |
| license_str | Other — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from SUNScholar — Stellenbosch University Repository |
| publishDate | 2019 |
| publishDateRange | 2019 |
| publishDateSort | 2019 |
| publisher | Stellenbosch : Stellenbosch University |
| publisherStr | Stellenbosch : Stellenbosch University |
| record_format | dspace |
| source_str | SUNScholar — Stellenbosch University Repository |
| spelling | oai:scholar.sun.ac.za:10019.1/106955 The value of repeat lumbar cerebrospinal fluid analysis in the diagnosis of childhood TBM Grobbelaar, Madelein Solomons, Regan Van Toorn, Ronald Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child Health. Lumbar spine Cerebrospinal fluid -- Examination diagnosis Meningitis, Tuberculous -- Diagnosis Tuberculosis patients' children Thesis (MMed)--Stellenbosch University, 2019. Objective: Early diagnosis and treatment initiation in childhood tuberculous meningitis (TBM) remains sub-optimal and contributes significantly to morbidity and mortality in this age group, especially in TB endemic areas. We aimed to describe the evolution of lumbar CSF parameters analyzed serially, to determine if re-sampling would influence the diagnostic accuracy of childhood TBM. Methods: We performed a retrospective observational study which included children with suspected TBM that were prospectively enrolled in several TBM research studies, at Tygerberg Hospital, Cape Town, South Africa, over a 30-year period. A data collection sheet was used to compare demographic, clinical and diagnostic characteristics on admission and subsequent repeat CSF parameters at weeks 1, 2 and 3. Results: Of 318 children with suspected TBM, 53(17%) patients had ‘definite’ TBM and 265(83%) patients had ‘probable’ TBM. Serial CSF analysis demonstrated a decrease in mean lymphocyte (143 to 49/μL) and neutrophil count (53 to 9/μL) over the 3-week period. Mean CSF protein also showed a gradual decline (3.29 to 1.85g/L) with a rise in mean CSF glucose (1.89 to 2.72 mmol/L) three weeks after initiating treatment. A total of 230 (72%) patients were identified that had atypical CSF trends; an increase in CSF lymphocyte, neutrophil and protein count after TBM treatment initiation. A history of prolonged illness >5days (p=0.01) and initial CSF neutrophil predominance (p<0.01) were associated with an atypical increase in serial CSF lymphocyte count, while a positive tuberculin skin test (p=0.05) and initial CSF lymphocyte predominance (p<0.01) were associated with an atypical increase in serial neutrophil count. Admission CSF protein level >1g/L (p<0.01) predicted an atypical serial increase in CSF protein. According to the uniform research case definition for TBM, 14% of patients with “possible” TBM, would have improved their diagnostic status to “probable” TBM after repeat CSF analysis. Conclusion: Repeat lumbar CSF in TBM suspects can demonstrate different trends over time. The typical trend is a gradual decline in CSF lymphocyte, neutrophil, and protein count whilst the CSF glucose rise steadily. It is not abnormal for the CSF lymphocyte, neutrophil, and protein count to rise initially after treatment initiation, which can be seen as atypical for TBM. Although serial lumbar CSF analysis improves the diagnosis of childhood TBM when the uniform TBM research case definition’s scoring system is applied, it does not improve early diagnosis and outcome and could cause confusion if an atypical trend is found. Mikpunte: Vroeë diagnose en behandeling van tuberkuleuse breinvliesontsteking in kinders bly sub optimaal en dra betekenisvol by tot morbiditeit en mortaliteit, veral in hoë TB-belaste nasies. Ons het beoog om die verandering in serebrospinale vog (SSV) parameters oor ‘n periode te beskryf om sodoende te bepaal of herhaal lumbale punksie ‘n merkwaardige invloed sal hê in die diagnose van kinder tuberkuleuse breinvliesontsteking. Metodes: Retrospektiewe ontleding van 318 kinders met ‘n suspisie van tuberkuleuse breinvliesontsteking oor ‘n 30 jaar periode, by die Tygerbergse Hospitaal, Kaapstad, Suid-Afrika. Demografiese, kliniese en diagnostiese eienskappe met opname, asook herhaal SVV ontleding 1, 2 en 3 weke later, is met mekaar vergelyk. Uitslae: Uit die 318 kinders met ‘n suspisie van tuberkuleuse breinvliesontsteking is 53(17%) gevalle bakteriologies bevestig en 265(83%) geïdentifiseer as waarskynlik tuberkuleuse breinvliesontsteking. SSV ontleding oor die 3-week periode het ‘n toename in gemiddelde limfosiet (143 na 49/μL) en neutrofiel telling (53 na 9/μL) getoon. Die gemiddelde proteïen konsentrasies het ook gelydelik afgeneem (3.29 to 1.85g/L) terwyl die SSV glukose vermeerder het oor die periode (1.89 na 2.72 mmol/L). Atipiese SSV patrone is gevind in 230 (72%) pasiënte na aanvang van behandeling, dit sluit in ‘n toename in SSV limfosiet, neutrofiel en proteïen telling. ‘n Geskiedenis van verlenge siekte >5 dae (p=0.01) en oorheersende SSV neutrofiele (p<0.01) was geassosieer met atipiese toename in SSV limfosiet telling, terwyl ‘n positiewe tuberkulien vel toets (p=0.05) en oorheersende SSV limfosiet (p<0.01) telling geassosieer was met atipiese toename in SSV neutrofiel telling. Aanvanklike proteïen konsentrasie >1g/L (p<0.01) was geassosieer met ‘n atipiese toename in SSV proteïen. Volgens die univorme navorsings gevalsdefinisie van tuberkuleuse meningitis, sou 14% van pasiënte met “moontlike” tuberkuleuse breinvliesontsteking, met herhaling van SVV, verander het na “waarskynlik” tuberkuleuse breinvliesontsteking. Gevolgtrekking: Herhaal SSV in kinders met die suspisie van tuberkuleuse breinvliesontsteking kan verskillende patrone wys. Die klassieke SSV patroon toon ‘n afname in limfosiet, neutrofiel en proteïen konsentrasies, met ‘n toename in SSV glucose. Aanvanklike toename in SSV limfosiet, neutrofiel en proteïen konsentrasies, na aanvang van behandeling, is wel bekend. Hierdie beeld kan as atipiese gesien word vir tuberkuleuse breinvliesontsteking. Alhoewel herhaal SSV die diagnose van tuberkuleuse breinvliesontsteking verbeter wanneer die univorme navorsings gevalsdefiniëring van tuberkuleuse meningitis gebruik word, dra dit nie by tot vroeër diagnose en beter uitkomste in kinders met tuberkuleuse breinvliesontsteking, en kan ‘n atipiese SSV patroon diagnostiese verwarring veroorsaak. Masters 2019-11-26T09:42:45Z 2019-12-11T06:40:15Z 2021-02-01T03:00:07Z 2019-12 Thesis http://hdl.handle.net/10019.1/106955 en_ZA Stellenbosch University application/pdf Stellenbosch : Stellenbosch University |
| spellingShingle | Lumbar spine Cerebrospinal fluid -- Examination diagnosis Meningitis, Tuberculous -- Diagnosis Tuberculosis patients' children Grobbelaar, Madelein The value of repeat lumbar cerebrospinal fluid analysis in the diagnosis of childhood TBM |
| title | The value of repeat lumbar cerebrospinal fluid analysis in the diagnosis of childhood TBM |
| title_full | The value of repeat lumbar cerebrospinal fluid analysis in the diagnosis of childhood TBM |
| title_fullStr | The value of repeat lumbar cerebrospinal fluid analysis in the diagnosis of childhood TBM |
| title_full_unstemmed | The value of repeat lumbar cerebrospinal fluid analysis in the diagnosis of childhood TBM |
| title_short | The value of repeat lumbar cerebrospinal fluid analysis in the diagnosis of childhood TBM |
| title_sort | value of repeat lumbar cerebrospinal fluid analysis in the diagnosis of childhood tbm |
| topic | Lumbar spine Cerebrospinal fluid -- Examination diagnosis Meningitis, Tuberculous -- Diagnosis Tuberculosis patients' children |
| url | http://hdl.handle.net/10019.1/106955 |
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