儿科学精品教学（重庆医科大学）14.Pediatric Tuberculosis.pptVIP

Which one is the typically cellular characteristics of CSF in TBM? 50-500 cells/mm3, with neutrophils predominance 50-500 cells/mm3, with mononuclear predominance 0-50 cells/mm3,with mononuclear predominance 1000, sometimes can above 10,000 with neutrophil predominance 0-50cells/mm3 with neutrophils predominance * * * CLINICAL MANIFESTIONS The whole process lasts for 3~4 weeks Characteristics of TBM in infants and young children A rapid onset with abruptly high fever or convulsion The progression is rapid Atypical meningeal irritation Intracranial hypertension manifests as bulging of anterior fontanelle and widening of cranial sutures in infant CLINICAL MANIFESTIONS INVESTIGATIONS Lab Studies Image studies 1. Cerebrospinal Fluid A. The appearance of CSF is yellow, or clear or opalescent. B. Opening pressure at initial lumbar puncture is significantly raised C. Cytology CSF leukocyte count usually ranges from 10 to 500 cells/mm3. Monocyte usually predominate. D. Biochemistry The protein level is elevated and may be markedly high. The glucose level is low. The chloridate level is low. INVESTIGATIONS-- Lab Studies 1. Cerebrospinal Fluid E. Microbiology The search for acid-fast bacilli (AFB) in CSF is the most crucial part of investigation. Acid-fast stain (+) Culture for M tuberculosis (+) Demonstration of AFB in CSF by microscopy in smear and by culture on LJ solid medium is the “gold standard” for diagnosis of TBM. The acid-fast stain of the CSF sediment is positive in up to 30% of cases and the culture is positive in 70%. INVESTIGATIONS-- Lab Studies 2. Tuberculin Skin Test Purified protein derivative (PPD) test PPD is injected intradermally on the volar surface of the forearm Reaction peaks at 48 to 72 hours A nonreactive result does not exclude M. tuberculosis infection or disease, the PPD n skin test is nonreactive in up to 50% of cases INVESTIGATIONS-- Lab Studies 1.Chest