DGI:ZNS-Infektionen/Tuberkulose Meningitis/Diagnostik: Difference between revisions

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== <span class="mw-headline" id="Diagnose" style="box-sizing: inherit;">Diagnose</span> ==
====Anamnese====


==== <span class="mw-headline" id="Anamnese" style="box-sizing: inherit;">Anamnese</span> ====
*Chronischer Husten? Gewichtsverlust? B-Symptomatik?
<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Symbol;&quot;}" style="box-sizing: inherit; font-family: Symbol;"><span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}" style="box-sizing: inherit;">· <span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font: 7pt \&quot;Times New Roman\&quot;;&quot;}" style="box-sizing: inherit; font: 7pt &quot;Times New Roman&quot;;">       </span></span></span>Chronischer <span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-family: Arial, sans-serif;">Husten? Gewichtsverlust? B-Symptomatik?</span>
*Reiseanamnese
*Herkunftsland
*Frühere Tbc-Diagnose oder Therapie, Tbc-Fall im sozialen Umfeld?


<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Symbol;&quot;}" style="box-sizing: inherit; font-family: Symbol;"><span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}" style="box-sizing: inherit;">· <span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font: 7pt \&quot;Times New Roman\&quot;;&quot;}" style="box-sizing: inherit; font: 7pt &quot;Times New Roman&quot;;">       </span></span></span><span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-family: Arial, sans-serif;">Reiseanamnese</span>
*Risikofaktoren:
**Malnutrition
**Immunsuppression
**Andere Infektionen, v.a. HIV (Bei Erstdiagnose Tbc immer HIV Test)
**Chronischer Alkoholabusus


<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Symbol;&quot;}" style="box-sizing: inherit; font-family: Symbol;"><span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}" style="box-sizing: inherit;">· <span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font: 7pt \&quot;Times New Roman\&quot;;&quot;}" style="box-sizing: inherit; font: 7pt &quot;Times New Roman&quot;;">       </span></span></span><span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-family: Arial, sans-serif;">Herkunftsland</span>
======Radiologie:======


<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Symbol;&quot;}" style="box-sizing: inherit; font-family: Symbol;"><span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}" style="box-sizing: inherit;">· <span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font: 7pt \&quot;Times New Roman\&quot;;&quot;}" style="box-sizing: inherit; font: 7pt &quot;Times New Roman&quot;;">       </span></span></span><span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-family: Arial, sans-serif;">Frühere Tbc-Diagnose oder Therapie, Tbc-Fall im sozialen Umfeld?</span>
*Röntgen-Thorax
*Sensitivität MRT > CT für pathogene Tbc-Assoziation
*Ggf. SPECT, PET


<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Symbol;&quot;}" style="box-sizing: inherit; font-family: Symbol;"><span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}" style="box-sizing: inherit;">· <span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font: 7pt \&quot;Times New Roman\&quot;;&quot;}" style="box-sizing: inherit; font: 7pt &quot;Times New Roman&quot;;">       </span></span></span><span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-family: Arial, sans-serif;">Risikofaktoren:</span>
======Mikrobiologie:======
 
Liquor
* Malnutrition
{| class="wikitable "
* Immunsuppression
|+
* Andere Infektionen, v.a. HIV (Bei Erstdiagnose Tbc immer HIV Test)
|+Tabelle 1: Differentialdiagnostische Liquoranalyse
* Chronischer Alkoholabusus
!
 
!Normal
====== <span class="mw-headline" id="Radiologie:" style="box-sizing: inherit;"><span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-family: Arial, sans-serif;">Radiologie''':'''</span></span> ======
!Virale Meningitis
<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Symbol;&quot;}" style="box-sizing: inherit; font-family: Symbol;"><span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}" style="box-sizing: inherit;">· <span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font: 7pt \&quot;Times New Roman\&quot;;&quot;}" style="box-sizing: inherit; font: 7pt &quot;Times New Roman&quot;;">       </span></span></span><span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-family: Arial, sans-serif;">Röntgen-Thorax</span>
!Bakterielle Meningitis
 
!Tuberkulöse Meningitis
<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Symbol;&quot;}" style="box-sizing: inherit; font-family: Symbol;"><span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}" style="box-sizing: inherit;">· <span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font: 7pt \&quot;Times New Roman\&quot;;&quot;}" style="box-sizing: inherit; font: 7pt &quot;Times New Roman&quot;;">       </span></span></span><span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-family: Arial, sans-serif;">Sensitivität MRT > CT für pathogene Tbc-Assoziation</span>
|-
!Aspekt
|Klar
|Klar
|Trüb
|Klar-trüb
|-
!Druck (cm H2O)
|5-12
|Normal oder (Pfeil nach oben)
|>20
|Normal oder (Pfeil nach oben)
|-
!Leukozyten (x 106/l)
|1-4
|< 1000 Lymphozyten
|> 1000
(> 70% Neutrophile)
|< 1000
(Mono- und Lymphozyten)
|-
!Glukose (% des Serumwertes)
|50-80%
|50-80%
|< 40%
|< 40%
|-
!Eiweiß (mg/l)
|150-500
|Normal oder (Pfeil nach oben)
|>> 500
| 500 > |
|-
!Laktat (mmol/l)
|< 1,6
|< 1,6
|> 3,5
|> 1,6
|-
!Direktpräparat
|Negativ
|Negativ
|80% positiv
|35% positiv
|}


<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Symbol;&quot;}" style="box-sizing: inherit; font-family: Symbol;"><span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}" style="box-sizing: inherit;">· <span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font: 7pt \&quot;Times New Roman\&quot;;&quot;}" style="box-sizing: inherit; font: 7pt &quot;Times New Roman&quot;;">       </span></span></span><span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-family: Arial, sans-serif;">Ggf. SPECT, PET</span>
====== <span class="mw-headline" id="Mikrobiologie:" style="box-sizing: inherit;"><span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-family: Arial, sans-serif;">Mikrobiologie''':'''</span></span> ======
<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-family: Arial, sans-serif;">Liquor</span>
{| class="MsoTableGrid" border="1" cellspacing="0" cellpadding="0" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; border-collapse: collapse; border-spacing: 0px; background-color: rgb(255, 255, 255); font-size: 14px; color: rgb(51, 51, 51); font-family: \&quot;Open Sans\&quot;, Roboto, arial, sans-serif; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; border: none;&quot;}" style="box-sizing: inherit; border-collapse: collapse; border-spacing: 0px; background-color: rgb(255, 255, 255); font-size: 14px; color: rgb(51, 51, 51); font-family: &quot;Open Sans&quot;, Roboto, arial, sans-serif; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; border: none;"
| style="width:80.5pt;" width="107" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:80.5pt;&quot;}" |
| style="width:53.95pt;" width="72" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:53.95pt;&quot;}" |'''<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Normal</span>'''
| style="width:92.1pt;" width="123" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:92.1pt;&quot;}" |'''<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Virale Meningitis</span>'''
| style="width:114.25pt;" width="152" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:114.25pt;&quot;}" |'''<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Bakterielle Meningitis</span>'''
| style="width:112pt;" width="149" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:112pt;&quot;}" |'''<span class="ve-pasteProtect" style="color: black" data-ve-attributes="{&quot;style&quot;:&quot;color: black&quot;}">Tuberkulöse Meningitis</span>'''
|- data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}" style="box-sizing: inherit;"
| style="width:80.5pt;" width="107" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:80.5pt;&quot;}" |<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;">Aspekt</span>
| style="width:53.95pt;" width="72" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:53.95pt;&quot;}" |<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;">klar</span>
| style="width:92.1pt;" width="123" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:92.1pt;&quot;}" |<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;">klar</span>
| style="width:114.25pt;" width="152" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:114.25pt;&quot;}" |<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;">trüb</span>
| style="width:112pt;" width="149" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:112pt;&quot;}" |<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;">klar-trüb</span>
|- data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}" style="box-sizing: inherit;"
| style="width:80.5pt;" width="107" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:80.5pt;&quot;}" |<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;">Druck</span>
<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;">(cm H<sub data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11px; line-height: 1; position: relative; vertical-align: baseline; bottom: -0.25em;&quot;}" style="box-sizing: inherit; font-size: 11px; line-height: 1; position: relative; vertical-align: baseline; bottom: -0.25em;">2</sub>O)</span>
| style="width:53.95pt;" width="72" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:53.95pt;&quot;}" |<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;">5-12</span>
| style="width:92.1pt;" width="123" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:92.1pt;&quot;}" |<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;">Normal oder</span> <span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Symbol;&quot;}" style="box-sizing: inherit; font-size: 11pt; font-family: Symbol;"><span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}" style="box-sizing: inherit;">­</span></span>
| style="width:114.25pt;" width="152" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:114.25pt;&quot;}" |<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;">> 20</span>
| style="width:112pt;" width="149" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:112pt;&quot;}" |<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;">Normal oder</span> <span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Symbol;&quot;}" style="box-sizing: inherit; font-size: 11pt; font-family: Symbol;"><span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}" style="box-sizing: inherit;">­</span></span>
|- data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}" style="box-sizing: inherit;"
| style="width:80.5pt;" width="107" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:80.5pt;&quot;}" |<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;">Leukozytenzahl</span>
<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;">(x 10<sup data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11px; line-height: 1; position: relative; vertical-align: baseline; top: -0.5em;&quot;}" style="box-sizing: inherit; font-size: 11px; line-height: 1; position: relative; vertical-align: baseline; top: -0.5em;">6</sup>/l)</span>
| style="width:53.95pt;" width="72" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:53.95pt;&quot;}" |<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;">1-4</span>
| style="width:92.1pt;" width="123" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:92.1pt;&quot;}" |<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;">< 1000</span>
<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;">Lymphozyten</span>
| style="width:114.25pt;" width="152" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:114.25pt;&quot;}" |<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;">> 1000</span>
<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;">(> 70% Neutrophile)</span>
| style="width:112pt;" width="149" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:112pt;&quot;}" |<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;">< 1000</span>
<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;">(Mono- und Lymphozyten)</span>
|- data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}" style="box-sizing: inherit;"
| style="width:80.5pt;" width="107" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:80.5pt;&quot;}" |<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;">Glukosegehalt</span>
<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;">(% des Serumwertes)</span>
| style="width:53.95pt;" width="72" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:53.95pt;&quot;}" |<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;">50-80%</span>
| style="width:92.1pt;" width="123" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:92.1pt;&quot;}" |<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;">50-80%</span>
| style="width:114.25pt;" width="152" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:114.25pt;&quot;}" |<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;">< 40%</span>
| style="width:112pt;" width="149" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:112pt;&quot;}" |<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;">< 40%</span>
|- data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}" style="box-sizing: inherit;"
| style="width:80.5pt;" width="107" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:80.5pt;&quot;}" |<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;">Eiweiß (mg/l)</span>
| style="width:53.95pt;" width="72" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:53.95pt;&quot;}" |<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;">150-500</span>
| style="width:92.1pt;" width="123" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:92.1pt;&quot;}" |<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;">Normal oder</span> <span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Symbol;&quot;}" style="box-sizing: inherit; font-size: 11pt; font-family: Symbol;"><span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}" style="box-sizing: inherit;">­</span></span>
| style="width:114.25pt;" width="152" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:114.25pt;&quot;}" |<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;">>> 500</span>
| style="width:112pt;" width="149" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:112pt;&quot;}" |<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;">>> 500</span>
|- data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}" style="box-sizing: inherit;"
| style="width:80.5pt;" width="107" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:80.5pt;&quot;}" |<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;">Laktat (mmol/l)</span>
| style="width:53.95pt;" width="72" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:53.95pt;&quot;}" |<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;">< 1,6</span>
| style="width:92.1pt;" width="123" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:92.1pt;&quot;}" |<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;">< 1,6</span>
| style="width:114.25pt;" width="152" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:114.25pt;&quot;}" |<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;">> 3,5</span>
| style="width:112pt;" width="149" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:112pt;&quot;}" |<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;">> 1,6</span>
|- data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}" style="box-sizing: inherit;"
| style="width:80.5pt;" width="107" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:80.5pt;&quot;}" |<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;">Direktpräparat</span>
| style="width:53.95pt;" width="72" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:53.95pt;&quot;}" |<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;">Negativ</span>
| style="width:92.1pt;" width="123" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:92.1pt;&quot;}" |<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;">Negativ</span>
| style="width:114.25pt;" width="152" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:114.25pt;&quot;}" |<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;">80% positiv</span>
| style="width:112pt;" width="149" valign="top" data-ve-attributes="{&quot;style&quot;:&quot;width:112pt;&quot;}" |<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-size: 11pt; font-family: Arial, sans-serif;">35% positiv</span>
|}
<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-family: Arial, sans-serif;">Tabelle 1: Differentialdiagnostische Liquoranalyse</span>


<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-family: Arial, sans-serif;">Goldstandard: Kultur auf Tbc (sensitiver als Mikroskopie, ist in bis zu 50-70% positiv). Dauer der Kultur bis 8 (-12) Wochen <span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}" style="box-sizing: inherit;">[8-12, 14, 15]</span>.</span>
Goldstandard: Kultur auf Tbc (sensitiver als Mikroskopie, ist in bis zu 50-70% positiv). Dauer der Kultur bis 8 (-12) Wochen <span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-family: Arial, sans-serif;"><span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}" style="box-sizing: inherit;"></span></span><ref name=":0">Schaberg T, Bauer T, Brinkmann F, et al. [Tuberculosis Guideline for Adults - Guideline for Diagnosis and Treatment of Tuberculosis including LTBI Testing and Treatment of the German Central Committee (DZK) and the German Respiratory Society (DGP)]. Pneumologie. 2017;71(6):325-397. doi:10.1055/s-0043-105954</ref><ref>Wilkinson RJ, Rohlwink U, Misra UK, et al. Tuberculous meningitis. Nat Rev Neurol. 2017;13(10):581-598. doi:10.1038/nrneurol.2017.120</ref><ref>Ducomble T, Tolksdorf K, Karagiannis I, et al. The burden of extrapulmonary and meningitis tuberculosis: an investigation of national surveillance data, Germany, 2002 to 2009. Euro Surveill. 2013;18(12):20436.</ref><ref>National Collaborating Centre for Chronic Conditions (UK), Centre for Clinical Practice at NICE (UK). Tuberculosis: Clinical Diagnosis and Management of Tuberculosis, and Measures for Its Prevention and Control. National Institute for Health and Clinical Excellence (UK); 2011. Accessed August 9, 2021. <nowiki>http://www.ncbi.nlm.nih.gov/books/NBK97852/</nowiki></ref><ref>Thwaites G, Fisher M, Hemingway C, et al. British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children. J Infect. 2009;59(3):167-187. doi:10.1016/j.jinf.2009.06.011</ref><span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-family: Arial, sans-serif;"><span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}" style="box-sizing: inherit;"></span></span><span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-family: Arial, sans-serif;"><span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}" style="box-sizing: inherit;"></span></span><ref>Chin JH. Tuberculous meningitis: Diagnostic and therapeutic challenges. Neurol Clin Pract. 2014;4(3):199-205. doi:10.1212/CPJ.0000000000000023</ref><span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-family: Arial, sans-serif;"><span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}" style="box-sizing: inherit;"></span></span><ref>Marais S, Thwaites G, Schoeman JF, et al. Tuberculous meningitis: a uniform case definition for use in clinical research. Lancet Infect Dis. 2010;10(11):803-812. doi:10.1016/S1473-3099(10)70138-9</ref><span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-family: Arial, sans-serif;"><span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}" style="box-sizing: inherit;"></span></span>.


<span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-family: Arial, sans-serif;">Xpert MTB/Rif, PCR zur Bestimmung von Tbc sowie Rifampicin-Resistenz, welches ein Hinweis für eine MDR-Tbc ist. Die Verlässlichkeit eines resistenten Ergebnisses (positiv prädiktiver Wert) ist abhängig von der Häufigkeit der Resistenz in der untersuchten Bevölkerung. Liegt die MDR-Rate, wie in Deutschland, unter 5%, sinkt der positiv prädiktive Wert auf unter 70% <span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}" style="box-sizing: inherit;">[1]</span>.</span>
Es sollte eine kulturelle Resistenzbestimmung für die Medikamente der Standardtherapie erfolgen sowie zusätzlich eine molekularbiologische Analyse hinsichtlich der Genabschnitte mit einer Isoniazid- und Rifampicinresistenz. Die Verlässlichkeit eines resistenten Ergebnisses (positiv prädiktiver Wert) ist abhängig von der Häufigkeit der Resistenz in der untersuchten Bevölkerung. Liegt die MDR-Rate, wie in Deutschland, unter 5%, sinkt der positiv prädiktive Wert auf unter 70% <ref name=":0" />


=== <span class="mw-headline" id="Differentialdiagnose" style="box-sizing: inherit;"><span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-family: Arial, sans-serif;">Differentialdiagnose</span></span> ===
===<span class="mw-headline" id="Differentialdiagnose" style="box-sizing: inherit;"><span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-family: Arial, sans-serif;">Differentialdiagnose</span></span>===


* Andere bakterielle Meningitiden (Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae, Listeria monocytogenes, Streptococcus, agalactiae), Neuroborreliose
*Andere bakterielle Meningitiden (''Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae, Listeria monocytogenes, Streptococcus, agalactiae''), Neuroborreliose
* <span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-family: Arial, sans-serif;">Pilze: Candida spp., Aspergillus spp., Kryptokokkus spp.</span>
*Pilze: ''Candida'' spp., ''Aspergillus'' spp., ''Kryptokokkus'' spp.
* <span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-family: Arial, sans-serif;">Parasiten: Echinokokkus spp., Toxoplasma</span>
*Parasiten: ''Echinokokkus'' spp., Toxoplasma
* <span class="ve-pasteProtect" data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit; font-family: Arial, sans-serif;&quot;}" style="box-sizing: inherit; font-family: Arial, sans-serif;">Nicht-infektiös: Sarkoidose, tumorös (Meningiosis carcinomatosa)</span>
*Nicht-infektiös: Sarkoidose, tumorös (Meningiosis carcinomatosa)

Latest revision as of 09:04, 17 March 2026

Anamnese

  • Chronischer Husten? Gewichtsverlust? B-Symptomatik?
  • Reiseanamnese
  • Herkunftsland
  • Frühere Tbc-Diagnose oder Therapie, Tbc-Fall im sozialen Umfeld?
  • Risikofaktoren:
    • Malnutrition
    • Immunsuppression
    • Andere Infektionen, v.a. HIV (Bei Erstdiagnose Tbc immer HIV Test)
    • Chronischer Alkoholabusus
Radiologie:
  • Röntgen-Thorax
  • Sensitivität MRT > CT für pathogene Tbc-Assoziation
  • Ggf. SPECT, PET
Mikrobiologie:

Liquor

Tabelle 1: Differentialdiagnostische Liquoranalyse
Normal Virale Meningitis Bakterielle Meningitis Tuberkulöse Meningitis
Aspekt Klar Klar Trüb Klar-trüb
Druck (cm H2O) 5-12 Normal oder (Pfeil nach oben) >20 Normal oder (Pfeil nach oben)
Leukozyten (x 106/l) 1-4 < 1000 Lymphozyten > 1000

(> 70% Neutrophile)

< 1000

(Mono- und Lymphozyten)

Glukose (% des Serumwertes) 50-80% 50-80% < 40% < 40%
Eiweiß (mg/l) 150-500 Normal oder (Pfeil nach oben) >> 500
Laktat (mmol/l) < 1,6 < 1,6 > 3,5 > 1,6
Direktpräparat Negativ Negativ 80% positiv 35% positiv


Goldstandard: Kultur auf Tbc (sensitiver als Mikroskopie, ist in bis zu 50-70% positiv). Dauer der Kultur bis 8 (-12) Wochen [1][2][3][4][5][6][7].

Es sollte eine kulturelle Resistenzbestimmung für die Medikamente der Standardtherapie erfolgen sowie zusätzlich eine molekularbiologische Analyse hinsichtlich der Genabschnitte mit einer Isoniazid- und Rifampicinresistenz. Die Verlässlichkeit eines resistenten Ergebnisses (positiv prädiktiver Wert) ist abhängig von der Häufigkeit der Resistenz in der untersuchten Bevölkerung. Liegt die MDR-Rate, wie in Deutschland, unter 5%, sinkt der positiv prädiktive Wert auf unter 70% [1]

Differentialdiagnose

  • Andere bakterielle Meningitiden (Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae, Listeria monocytogenes, Streptococcus, agalactiae), Neuroborreliose
  • Pilze: Candida spp., Aspergillus spp., Kryptokokkus spp.
  • Parasiten: Echinokokkus spp., Toxoplasma
  • Nicht-infektiös: Sarkoidose, tumorös (Meningiosis carcinomatosa)
  1. ↑ 1.0 1.1 Schaberg T, Bauer T, Brinkmann F, et al. [Tuberculosis Guideline for Adults - Guideline for Diagnosis and Treatment of Tuberculosis including LTBI Testing and Treatment of the German Central Committee (DZK) and the German Respiratory Society (DGP)]. Pneumologie. 2017;71(6):325-397. doi:10.1055/s-0043-105954
  2. ↑ Wilkinson RJ, Rohlwink U, Misra UK, et al. Tuberculous meningitis. Nat Rev Neurol. 2017;13(10):581-598. doi:10.1038/nrneurol.2017.120
  3. ↑ Ducomble T, Tolksdorf K, Karagiannis I, et al. The burden of extrapulmonary and meningitis tuberculosis: an investigation of national surveillance data, Germany, 2002 to 2009. Euro Surveill. 2013;18(12):20436.
  4. ↑ National Collaborating Centre for Chronic Conditions (UK), Centre for Clinical Practice at NICE (UK). Tuberculosis: Clinical Diagnosis and Management of Tuberculosis, and Measures for Its Prevention and Control. National Institute for Health and Clinical Excellence (UK); 2011. Accessed August 9, 2021. http://www.ncbi.nlm.nih.gov/books/NBK97852/
  5. ↑ Thwaites G, Fisher M, Hemingway C, et al. British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children. J Infect. 2009;59(3):167-187. doi:10.1016/j.jinf.2009.06.011
  6. ↑ Chin JH. Tuberculous meningitis: Diagnostic and therapeutic challenges. Neurol Clin Pract. 2014;4(3):199-205. doi:10.1212/CPJ.0000000000000023
  7. ↑ Marais S, Thwaites G, Schoeman JF, et al. Tuberculous meningitis: a uniform case definition for use in clinical research. Lancet Infect Dis. 2010;10(11):803-812. doi:10.1016/S1473-3099(10)70138-9
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