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Editorial

Pitfalls in clinical diagnosis and treatment of

infectious meningitis in China

Jia‑Tang Zhang
Department of Neurology, Chinese PLA General Hospital, Beijing 100853, China.

INTRODUCTION as well as basic research data. The data on meningitis
in current textbooks are about 40–50 years old, and
Infectious disease of the central nervous system (CNS), some are from foreign studies, whereas the chapters on
such as meningitis, is one of the most important cerebrovascular disease are updated every 5–10 years.
categories of neurological conditions. Such diseases (3) The clinical manifestations of meningitis can be
are challenging in terms of diagnosis, treatment, and atypical. Meningitis has shown the greatest change
prognosis. Meningitis occurs most often in young- and in clinical manifestations over time compared with
middle-aged patients, and the rate of misdiagnosis, other nervous system diseases. “Atypical clinical
especially during the early stages of the disease, is high. manifestations” may, in fact, be the current “typical”
Correct diagnosis and treatment can save lives, but features, but are different from the manifestations
many factors, such as difficulty in medications crossing seen 50 years ago. The 50-year fight between the
the blood-brain barrier (BBB) can cause difficulty in meningitis pathogen and the human immune system,
treatment. the natural variation of the pathogenic organisms, the
misuse of antibiotics and immune suppressants, and
ANALYSIS OF THE MISDIAGNOSIS RATE OF the prevalence of drug addiction and AIDS have all
INFECTIOUS MENINGITIS produced changes in the clinical manifestations of
meningitis. (4) Obtaining samples of the pathogen is
There are several reasons for the high rate of difficult. Taking a biopsy from the mater has technical
misdiagnosis in meningitis: (1) the development of limitations, and it may be difficult for the patient and
this clinical sub-specialty is relatively recent. The family to accept. The positivity rate for pathogens in
professional setting and staffing for research into CSF is very low, except for Cryptococcus neoformans,
infectious CNS diseases fall behind those for research which can be 99% in most references. [1,2] The textbooks
into cerebrovascular, demyelinating, neuromuscular, state that the positivity rate for Mycobacterium
degenerative, and genetic diseases. At present, tuberculosis by smear and culture of bacteria from
only a few hospitals in China, such as in Beijing, CSF can be as high as 30%–40%, but clinical reports
Shanghai, Xi’an, Shijiazhuang, and Yinchuan, have from most hospitals show a positive rate of below 10%.
infection and cerebrospinal fluid cytology (CSFC) Of 167 patients with tubercular meningitis who were
as a professional sub-specialty. (2) The content of assessed during the period 1990–2010 in our hospital,
current textbooks is out of date. It lacks data from only one had a positive result for M. tuberculosis by
large, double-blind, multicenter, case–control studies, bacterial smear and culture from CSF samples. Using
[3]
the new acid-fast stain method of The Fourth Military
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Medical University, the positivity rate of CSF smear can
Quick Response Code: be above 90%, enabling early diagnosis of tubercular
Website: meningitis. Identifying the pathogens underlying
[4]
www.nnjournal.net
cases of viral meningitis, weakly pathogenic bacterial
DOI: meningitis, and parasitic meningitis is also difficult. For
10.4103/2347-8659.135566 these reasons, the misdiagnosis rate in early meningitis
is very high.

Corresponding Author: Dr. Jia‑Tang Zhang, Department of Neurology, Chinese PLA General Hospital, No. 28 Fuxing Road,
Haidian, Beijing 100853, China. E‑mail: edwin‑zhang@263.net

Neuroimmunol Neuroinflammation | Volume 1 | Issue 1 | June 2014 3