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

Abstract	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.
Authors	J F Schoeman, J W Elshof, J A Laubscher, A Janse van Rensburg, P R Donald
Journal	Annals of tropical paediatrics (Ann Trop Paediatr) Vol. 21 Issue 4 Pg. 299-305 (Dec 2001) ISSN: 0272-4936 [Print] England
PMID	11732147 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial)
Chemical References	Antitubercular Agents Cerebrospinal Fluid Proteins Globulins Glucocorticoids Lactic Acid Adenylate Kinase Glucose Prednisone Rifampin
Topics	Adenylate Kinase (cerebrospinal fluid) Antitubercular Agents (therapeutic use) Cerebrospinal Fluid Proteins (analysis) Child Child, Preschool Drug Interactions Drug Therapy, Combination Female Globulins (cerebrospinal fluid) Glucocorticoids (therapeutic use) Glucose (cerebrospinal fluid) Humans Infant Lactic Acid (cerebrospinal fluid) Lymphocyte Count Male Neutrophils Prednisone (therapeutic use) Rifampin (pharmacology) Statistics, Nonparametric Tuberculosis, Meningeal (cerebrospinal fluid, drug therapy)

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