Analysis on misdiagnosis of tuberculous meningitis in the elderly
2017
Objective
To explore the clinical characteristics of elderly patients with tuberculous meningitis (TBM) and analyze the causes of misdiagnosis.
Methods
The clinical data of patients aged 60 years and over with TBM in Beijing Chest Hospital Affiliated to Capital Medical University from January 2011 to January 2017 were retrospectively analyzed.The clinical characteristics of the elderly patients with TBM were analyzed and compared between misdiagnosis and non-misdiagnosis groups.
Results
Among 60 elderly patients with TBM, 32 cases (53.3%) were misdiagnosed before hospitalization.Among 32 misdiagnosed cases, 11 (34.4%) were misdiagnosed as pulmonary infection, 6 (18.8%) as infectious diseases with unspecified site, 4(12.5%) as upper respiratory tract infections and 3 (9.4%) as cerebral vascular diseases, and so on.The onset time of TBM, fever prevalence and CSF glucose levels were 42.5 (20.3, 60.0) d, 96.9% (31 cases), 1.5(1.1, 2.3)mmol/L in misdiagnosis group respectively, and 15.0 (10.0, 20.0) d, 75.0%(21 cases), 2.3(1.4, 3.2)mmol/L in non-misdiagnosis group respectively, which was statistically significantly different between the two groups (all P 0.05).
Conclusions
Elderly patients with TBM have atypical clinical manifestations, many comorbidities, and less specific imaging, and especially, the cerebrospinal fluid pathogen sensitivity is low, which may result in higher misdiagnosis rate.
Key words:
Tuberculosis, meningeal; Diagnostic errors
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