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tuberculous meningitis, and are sometimes accompanied REFERENCES
by ring enhancement of tuberculoma. These signals
[9]
are weakest for viral meningitis and may sometimes 1. Adam P, Sobek O, Dolezil D, Lodin Z, Kasík J, Hajduková L,
be absent. Cihelková S, Svatonová J, Hybel’ová M, Adam D, Melezinková
V. Cryptococcal meningitis – a follow‑up study of a serious clinical
entity: quick cytological and microbiological diagnostics using a
How to determine the diagnosis and treatment strategy special staining procedure in cerebrospinal fluid specimens. Folia
without identifying the pathogen? Microbiol (Praha) 2009;54:567‑8.
It is difficult to determine the diagnosis and treatment 2. Fan XH, Feng GD, Yang YN, Dai W, Zhao G. Diagnostic value
strategy without having pathogen identification. On of May‑Grunwald‑Giemsa staining of cerebrospinal fluid in
patients with cryptococcal meningitis. J Int Neurol Neurosurg
the basis of that stated above, experimental therapy 2013;40:220‑2.
can be carried out for 2–3 weeks if we have propensity 3. Hu J, Zhang JT, Lang SY, Pu CQ. Analysis of cerebrospinal fluid from
diagnosis, and then the subsequent strategy can be 167 cases of tuberculous meningitis. Med J Chin Peoples Liberation
determined based on the effect of treatment. If there is 4. Army 2010;35:580‑3.
Chen P, Shi M, Feng GD, Liu JY, Wang BJ, Shi XD, Ma L,
no tendency for diagnosis, my personal experience is Liu XD, Yang YN, Dai W, Liu TT, He Y, Li JG, Hao XK, Zhao G.
as follows. A highly efficient Ziehl‑Neelsen stain: identifying de novo
intracellular Mycobacterium tuberculosis and improving detection of
Step 1: we treat the condition as viral meningitis extracellular M. tuberculosis in cerebrospinal fluid. J Clin Microbiol
for 2–3 weeks. This treatment can continue if there 5. 2012;50:1166‑70.
Pardridge WM. Drug targeting to the brain. Pharm Res
is a positive effect on the clinical, CSF, or imaging 2007;24:1733‑44.
findings; otherwise, we go on to the next step. Step 2: 6. Prasad K, Sahu JK. Duration of anti‑tubercular treatment in
we treat it as tuberculous meningitis for 2–3 weeks. tuberculous meningitis: challenges and opportunity. Neurol India
This treatment can continue if there is a positive effect 7. 2010;58:723‑6.
Hu J, Zhang JT, Lang SY, Pu CQ. Clinical analysis of 47 misdiagnosed
on the clinical, CSF, or imaging findings; otherwise, cases of atypical tuberculous meningitis. Nan Fang Yi Ke Da Xue
we go on to the next step. Step 3: we treat it as C. Xue Bao 2011;31:175‑9. (in Chinese)
neoformans meningitis for 2–3 weeks, and then assess 8. Wang JT, Hung CC, Sheng WH, Wang JY, Chang SC, Luh KT. Prognosis
the effect. of tuberculous meningitis in adults in the era of modern antituberculous
chemotherapy. J Microbiol Immunol Infect 2002;35:215‑22.
9. Feng WJ, Zhang Y, Liu X, Liu B. The imaging characteristic of CT
During every treatment step, efforts must continue of tuherculous meningitis. Mod Med Image 2009;18:207‑10
to identify the pathogen and then re-diagnose.
If the pathogen is identified, targeted treatment Cite this article as: Zhang JT. Pitfalls in clinical diagnosis and treatment of
can commence; otherwise, we can only perform infectious meningitis in China. Neuroimmunol Neuroinflammation 2014;1(1):3-5.
experimental therapy based on the clinical, CSF, or Source of Support: Nil. Conflict of Interest: No.
imaging findings. Received: 03-05-2014; Accepted: 29-05-2014

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