Differential diagnosis of tuberculous meningitis

CSF abnormalities

Disease

White cells

Protein

Glucose

Microscopy

tuberculous meningitis

Elevated L > PMN

Increased

Decreased

(in some cases)

cryptococcal meningitis*

Elevated L > PMN

Increased

Decreased

Positive India ink staining

partially treated bacterial meningitis*

Elevated

Increased

Decreased

Bacteria on Gram stain (rarely)

viral meningitis

Elevated L > PMN

Increased

Normal (low in mumps or H. simplex)

acute syphilis

Elevated L > PMN

Increased

Normal

late stage trypanosomiasis

Elevated L > PMN

Increased

Decreased

Motile trypanosomes

tumour

(carcinoma/

lymphoma)

Elevated L > PMN

Increased

Decreased

Cytology shows malignant cells

leptospirosis

Elevated L > PMN

Increased

Decreased

Leptospires

amoebic meningitis

Elevated L > PMN

Increased

Decreased

Amoebae

PMN = polymorphonuclear leukocytes; L = lymphocytes * common differential diagnosis

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