The intrathecal tuberculin reaction

The isolation of Mycobacterium tuberculosis by filtration technique from cerebrospinal fluid

Collection on a filter membrane as a routine culture method has proved of great advantage in the isolation of Mycobacterium tuberculosis from the cerebrospinal fluid. Its use, during combined intrathecal treatment with streptomycin and Purified Protein Derivative of tuberculin, shows that the organisms persist for an unexpectedly long time in the cerebrospinal fluid. In some instances, focal reaction to P.P.D. seems to liberate tubercle bacilli from the lesions into the fluid. Direct culture of C.S.F. on Loewenstein medium gave less than two positive specimens per patient and no positive cultures later than the second week of treatment. Filtration gave more profuse growth and persistence of positive cultures during treatment for as long as 28 weeks in some cases.

The effect of adjuvant steroid treatment on serial cerebrospinal fluid changes in tuberculous meningitis

Three recent studies found that corticosteroids improve clinical outcome and mortality in tuberculous meningitis (TBM), although the exact mechanism of action of the drug remains speculative. A number of reports on the effect of corticosteroids on cerebrospinal fluid (CSF) findings in TBM have been published, often with conflicting results regarding serial cell counts and protein levels. As part of a controlled, randomized trial on the effect of oral prednisone on outcome in childhood TBM at our institution, CSF was collected and analysed weekly during the 1st month of treatment. We found no significant difference in serial CSF cell counts between the steroid and non-steroid groups in the study. However, the steroid group had significantly lower CSF protein and globulin levels after the 1st month of treatment, and a more steady rise in CSF glucose levels than the non-steroid group. Knowledge of the different CSF responses during the course of anti-tuberculosis therapy is important in clinical decision-making.

Hypersensitivity in newborn guinea pigs

Neonatal guinea pigs during the first 2 weeks of life did not indicate the presence of delayed hypersensitivity intradermally, after sensitization with purified soluble antigens in dose levels that induced detectable delayed hypersensitivity in the skin of adults. Although Arthus type allergy was detectable in newborns, circulating antibody frequently preceded its appearance by several days. Passive Arthus reactions were not produced in newborns as readily as in adults. Contact hypersensitivity and allergic encephalomyelitis were induced in newborns, but corneal reactions were not. Total body irradiation with 200 r inhibited antibody formation in newborns, as in adults. In addition, the induction period for anamnestic responses in newborns and the antigen elimination rate were the same as in adults. Passive transfer of delayed hypersensitivity from sensitized newborns to normal adults was accomplished.

Cerebrospinal fluid investigations in tuberculous meningitis

The results of conventional cerebrospinal fluid (CSF) investigations (CSF cell count, protein and glucose concentrations and Pandy's test for CSF globulin) obtained on admission and sequentially from weekly follow-up lumbar punctures for 4 weeks were evaluated in 99 children (median age 28 months) with stage II (50 children) and stage III (49 children) tuberculous meningitis. On admission, six children (6%) had a CSF cell count greater than 500 x 10(6)/l and nine (9%) a polymorphonuclear predominance. A CSF protein less than 0.8 g/l was found in 17 children (18%) of 97 in whom CSF protein was evaluated. Globulin was either absent or present as a trace only in 26 children (27%). CSF glucose was less than 2.2 mmol/l in 58 cases (60%) and less than 2.5 mmol/l in 67 (69%). In 63 children weekly CSF specimens obtained for the 1st 4 weeks of therapy showed an uninterrupted decline in cell count in 23 (37%), a fluctuating downward trend in 27 (43%) and a fluctuating upward trend in 13 (21%). Sequential CSF protein values in 57 children showed an uninterrupted rise in three (5%), a fluctuating upward course in 19 (33%), an uninterrupted downward trend in seven (12%), and a fluctuating downward course in 28 (49%). Of the 61 children in whom sequential CSF glucose concentrations were available, 11 (18%) experienced fluctuating concentrations, values falling to less than 2.2 mmol/l after being greater than 2.2 mmol/l on admission or after having risen to greater than 2.2 mmol/l.(ABSTRACT TRUNCATED AT 250 WORDS)

Pathophysiological correlates in bacterial meningitis

This review summarises briefly several areas of importance in the pathogenesis of bacterial meningitis. These subjects include: (1) factors that predispose to the development of disease and relevant host defense mechanisms; (2) microbial virulence factors; (3) the route(s) of entry for bacteria into the cerebrospinal fluid (CSF); (4) the role of pathological changes in the central nervous system; (5) particulate clearance mechanisms operative in the CSF system; and (6) the physiological alteration in normal intracranial homeostatic processes.

Tuberculous meningitis of acute onset

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An unusual cutaneous reaction in mental defectives after vole bacillus vaccination by multiple puncture and its treatment

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