Tuberculous Meningitis in Province-2, Southern Nepal

Abstract Introduction Tuberculosis (TB) still remains a public health challenge in Nepal. As per the World Health Organisation (WHO), five countries, viz., India, China, Pakistan, Indonesia and South Africa, account for over 70% of the global burden of disease. Tuberculous meningitis (TBM) is the most severe type of extra pulmonary tuberculosis, which remains an undiagnosed disease and sparse data available for this disease in Nepal Methods: We included all patients admitted with tubercular meningitis between May 2018 to August 2019 admitted in Terai Hospital and Research centre. Diagnosis of Tubercular meningitis was confirmed by combined clinical sign and symptoms, CSF biochemical values of lymphocytic pleocytosis, high protein, low sugars with high CSF ADA and the therapeutic response to National Tuberculosis programme Category 1 (NTP CAT-1) antituberculous treatment (ATT) Results: The mean age was 48.5 ±30 years and male/female ratio was 12/14. Most of them had fever and neck rigidity. CSF studies in all the patients showed lymphocytic exudate with CSF pleocytosis varying from 14to1500cells/cumm. CSF protein was 51-319 mg/dl, CSF sugar was17-165 mg/dl and CSF ADA was10-38 units/l. Conclusions: Our study concluded that clinical presentation of fever, nuchal rigidity and CSF lymphocytic pleocytosis with CSF ADA value of ≥ 10 is sufficient to consider the diagnosis of Tubercular meningitis in a resource limited setting where the newer sophisticated and expensive tests are not readily available or affordable