Case of Mycobacterium tuberculosis meningitis: Gram staining as a useful initial diagnostic clue for tuberculous meningitis
| Autor: | Sayoko Kawakami, Yukihisa Miyazawa, Yasuyosi Kawamura, Kyouhei Nishiyama, Hiroki Hatanaka, Ryuichi Fujisaki, Hajime Nishiya, Yasuo Ono |
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| Rok vydání: | 2012 |
| Předmět: |
Adult
Male Microbiology (medical) Pathology medicine.medical_specialty Tuberculosis Antitubercular Agents Tuberculous meningitis law.invention Mycobacterium tuberculosis law medicine Humans Pharmacology (medical) Pleocytosis Neck stiffness Staining and Labeling biology business.industry biology.organism_classification medicine.disease Bacterial Typing Techniques Staining Infectious Diseases Gram staining Tuberculosis Meningeal Phenazines Gentian Violet business Meningitis |
| Zdroj: | Journal of Infection and Chemotherapy. 18:931-936 |
| ISSN: | 1341-321X |
| DOI: | 10.1007/s10156-012-0382-y |
| Popis: | A 32-year-old man was admitted to our hospital because of fever, headache, and loss of consciousness. Four days before admission, he had had difficulty speaking. On the day of admission, his colleague had found him to be unconscious and lying on his back. He was admitted to our hospital. The temperature at the eardrum was 35.2°C. Neurologic evaluation was negative. Computed tomography (CT) scan of the brain showed slight ventricular enlargement bilaterally. An X-ray film of the chest showed no abnormality. On the second hospital day, neck stiffness was noted. The cerebrospinal fluid (CSF) contained 870 white cells/μl, most of which were neutrophils; the glucose level in the CSF was 10 mg/dl, and the protein level was 140 mg/dl. Stained smears of the CSF, including Gram staining and India-ink preparations, disclosed no microorganisms. Capsular antigen tests for several bacteria were negative. Antimicrobial agents were started. However, by changing the microscope focus slightly while viewing Gram stains of the CSF, we could see brightened and Gram-positive bacilli that had been phagocytosed by neutrophils. This finding suggested the presence of Mycobacterium tuberculosis. Ziehl-Neelsen staining of the CSF and gastric juice revealed anti-acid bacilli. Polymerase chain reaction for M. tuberculosis in the gastric juice was positive. This case showed that Gram staining could be useful as an initial adjunct for the diagnosis of tuberculous meningitis, particularly when the CSF shows predominantly neutrocytic pleocytosis, but no other evidence of bacterial meningitis. |
| Databáze: | OpenAIRE |
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