CEREBROSPINAL-FLUID INVESTIGATIONS IN TUBERCULOUS MENINGITIS

The results of conventional cerebrospinal fluid (CSF) investigations (CSF cell count, protein and glucose concentrations and Pandy's test for CSF globulin) obtained on admission and sequentially from weekly follow-up lumbar punctures for 4 weeks were evaluated in 99 children (median age 28 months) with stage II (50 children) and stage III (49 children) tuberculous meningitis. On admission, six children (6%) had a CSF cell count > 500 x 10(6)/l and nine (9%) a polymorphonuclear predominance. A CSF protein < 0.8 g/l was found in 17 children (18%) of 97 in whom CSF protein was evaluated. Globulin was either absent or present as a trace only in 26 children (27%). CSF glucose was < 2.2 mmol/l in 58 cases (60%) and < 2.5 mmol/l in 67 (69%). In 63 children weekly CSF specimens obtained for the 1st 4 weeks of therapy showed an uninterrupted decline in cell count in 23 (37%), a fluctuating downward trend in 27 (43%) and a fluctuating upward trend in 13 (21%). Sequential CSF protein values in 57 children showed an uninterrupted rise in three (5%), a fluctuating upward course in 19 (33%), an uninterrupted downward trend in seven (12%), and a fluctuating downward course in 28 (49%). Of the 61 children in whom sequential CSF glucose concentrations were available, 11 (18%) experienced fluctuating concentrations, values falling to < 2.2 mmol/l after being > 2.2 mmol/l on admission or after having risen to > 2.2 mmol/l. Fluctuations in the CSF cell count and the protein and glucose concentrations during the 1st month of therapy even when intrathecal therapy is not administered are not unusual and should not deter the clinician from continuing antituberculous therapy. Initial CSF findings within the range expected for a viral meningitis occurred in 15 (15%) of the children.