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)
*Chronischer Alkoholabusus
 
======<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>======
<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>
 
<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>
 
<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="wikitable sortable mw-collapsible filterable 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;}" |
|+Tabelle 1: Differentialdiagnostische Liquoranalyse
| 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>'''
!Normal
| 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>'''
!Virale Meningitis
| 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>'''
!Bakterielle Meningitis
|- data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}" style="box-sizing: inherit;"
!Tuberkulöse Meningitis
| 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>
!Aspekt
| 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>
|Klar
| 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>
|Klar
| 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>
|Trüb
|- data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}" style="box-sizing: inherit;"
|Klar-trüb
| 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>
!Druck (cm H2O)
| 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>
|5-12
| 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>
|Normal oder (Pfeil nach oben)
| 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>
|>20
| 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>
|Normal oder (Pfeil nach oben)
|- 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>
!Leukozyten (x 106/l)
<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>
|1-4
| 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>
|< 1000 Lymphozyten
| 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>
|> 1000
<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>
(> 70% Neutrophile)
| 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>
|< 1000
<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>
(Mono- und Lymphozyten)
| 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>
!Glukose (% des Serumwertes)
|- data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}" style="box-sizing: inherit;"
|50-80%
| 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>
|50-80%
<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>
|< 40%
| 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>
|< 40%
| 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>
!Eiweiß (mg/l)
| 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>
|150-500
|- data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}" style="box-sizing: inherit;"
|Normal oder (Pfeil nach oben)
| 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>
|>> 500
| 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>
| 500 > |
| 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>
!Laktat (mmol/l)
| 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>
|< 1,6
|- data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}" style="box-sizing: inherit;"
|< 1,6
| 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>
|> 3,5
| 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>
|> 1,6
| 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>
!Direktpräparat
| 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>
|Negativ
|- data-ve-attributes="{&quot;style&quot;:&quot;box-sizing: inherit;&quot;}" style="box-sizing: inherit;"
|Negativ
| 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>
|80% positiv
| 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>
|35% positiv
| 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</span></span><ref><span style="color: rgb(51, 51, 51)">Schaberg T, 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;</span> '''71'''<span style="color: rgb(51, 51, 51)">(6): 325-397</span><br /></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;">-12</span></span><ref> <span style="color: rgb(51, 51, 51)">Thwaites G, 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;</span> '''59'''<span style="color: rgb(51, 51, 51)">(3): 167-87</span><br /></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;">, 14</span></span><ref><span style="color: rgb(51, 51, 51)">Chin JH, Tuberculous meningitis: Diagnostic and therapeutic challenges. Neurol Clin Pract, 2014;</span> '''4'''<span style="color: rgb(51, 51, 51)">(3):199-205</span><br /></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;">, 15</span></span><ref><span style="color: rgb(51, 51, 51)">Marais S, et al., Tuberculous meningitis: a uniform case definition for use in clinical research. Lancet Infect Dis, 2010;</span> '''10'''<span style="color: rgb(51, 51, 51)">(11): 803-12</span><br /></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><ref><span style="color: rgb(51, 51, 51)">Vincent JL, Rello J, Marshall J, Silva E, Anzueto A, Martin CD, Moreno R, Lipman J, Gomersall C, Sakr Y, Reinhart K, EPIC II Group of Investigators. International study of the prevalence and outcomes of infection in intensive care units. JAMA 2009; 2;302(21):2323-9</span></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>
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>.
 
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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