| [Background] Along with the application of organ transplantation, the wider use of broad-spectrum antimicrobial agents, the increased application of adrenal cortical hormones, immunosuppressants,, anti-tumor chemotherapy drugs and the AIDS epidemic, infection of the central nervous system have increased gradually in recent years. Tuberculous meningitis and cryptococcal meningitis were the two most common types of central nervous system infections. The similarity of clinical manifestation, early diagnosis difficulties, delays in the timing of treatment, lead the increase of increased mortality and morbidity of these two different infections.[Objective] To compare the clinical characteristics, in particular the laboratory examination of cerebrospinal fluid examination and imaging features. Discuss early diagnostic methods, and provide evidences for rational diagonosis and therapy.[Method] Retrospectively review the data of 327 cases confirmed as tuberculous meningitis from Janruary 2002 to December 2006 and 96 cases confirmed as cryptococcus meningitis from July 1996 to February 2007. The clinical materials include the general material, underlying disease, pattern of onset, clinical manifestations, laboratory examination, especially CSF results, imaging features, therapeutics and curative effect. Then individual database was established, then analyzed retrospectively. Count information expressed in percentage, measurement data with mean±standard deviation (X±S), Using SPSS 10.0 software for the Chi-square test or the exact probability calculation.[Results] A total of 327 cases of tuberculous meningitis and 96 cases of cryptococcal meningitis were enrolled. Male patients were derminant.Aged 30-40 yeas old (the age range of TBM was from 7 to 83 yrs, the mean age was 33.19±15.67 yrs; the age range of CN was from 6 to 86 yrs, the mean age was 39.74±15.99 yrs). Farmers were dominant.In 327 Tuberculous meningitis cases, 94 (28.74%) co-existed underlying diseases. And in 96 Cryptococcal meningitis patients, 68 (70.83%) with the underlying disease.In 327 cases of tuberculous meningitis patients, 292(89.3%) with fever on admission, 309 with headache(94.5%), 212 with vomiting(64.83%). In 96 cases of cryptococcal meningitis patients, hospitalized with fever in 63 cases (65.6%), headache in 92 cases (98.9%), vomiting in 64 cases (66.67%).About blood tests, 42 out of 327 cases of tuberculous meningitis patients had anemia (12.84%), WBC increased (＞10.0×10~9/L) in 63 cases (19.27%), Categories mainly as neutrophils (＞70%) of 247 cases(75.54%), lymphocyte predominance (＞40%) only in three cases. In 96 cases of cryptococcal meningitis patients, there were 10 cases with anemia (10.42%). 22 cases with WBC increased (＞10.0×10~9/L), accounting for 22.92%. Classification mainly as neutrophils (＞70%) of 70 cases (72.92%), lymphocyte predominance (＞40%) O.In 327 Tuberculous meningitis patients, 301 existed CSF leukocyte counts increasing(92.04%), trace protein increased in 303 cases (93%), glucose decreasing in 205 cases (64.26%), lowering chloride were 267 cases (81.7%). In 96 cases of cryptococcal meningitis patients, cerebrospinal fluid leukocyte counts increased in 83 cases (86.47%), trace protein increased in 80 cases (83.33%), glucose decreased in 62 cases (64.58%), CSF chloride reduction in 59 cases (61.5%).In 327 Tuberculous meningitis patients, 178 patients had done a head CT examination, abnormality found in 118 cases (66.67%). A total of 111 cases done brain MRI, 98 patients revealed problem(88.28%). In 96 cases of cryptococcal meningitis patients, 40 cases had a brain CT examination, 24 patients had abnormal CT results (60%). 32 cases had brain MRI, 30 patients (93.75%) demonstrated problem.Pathogens test of 96 cases of cryptococcal meningitis, all found cryptococcus sp. by smear staining or culture. In 327 cases of tuberculous meningitis patients, 10 cases found Mycobacterium tuberculosis by smear antiacid staining or pathological examination, 9 cases found M. tuberculosis by quantitative PCR only involved in44 patients.In 327 Tubercular meningitis, none was cured, and marked improvement in 219 cases (66.97%), improvement in 47 cases (14.37%), failure in 24 cases (7.41%). 6 cases(1.83%) deaths, 30 cases(9.17%) withdrawn from our hospital. The total effectiveness rate was 81.65%. In 96 cases of patients with cryptococcal meningitis, 3 were cured and marked improvement in 47 cases, improvement in 6 cases, failure in 5 cases. There were 14 patients died, 24 cases withdrawn from our hospital. The total effectiveness rate was 58.33%.[Conclusion]1. Tuberculous meningitis and cryptococcal meningitis are mainly attack male persons, especially in young adults. The therapeutic results showed that tuberculous meningitis is more efficient than cryptococcal meningitis.2. More than two-thirds cryptococcal meningitis patients had underlying diseases, tuberculosis meningitis is associated with one-third of underlying diseases.3. Of tuberculous meningitis, fever is the most important symptom, and for cryptococcal meningitis, headache is an important symptom. 4. Leukocyte count in CSF is not high, but both showed the proportion of the neutral increased.5. The CSF pressure of cryptococcal meningitis increased higer than that of tuberculous meningitis. The trace protein of tuberculous meningitis was significantly higher than that in cryptococcal meningitis, chloride of tuberculous meningitis was lower than that in cryptococcal meningitis. The CSF glucose of cryptococcal meningitis is lowerer than that of tuberculous meningitis. The elevation of WBC in CSF had no differences between two kind meningitis.6. MRI is more effective for brain lesions finding than CT.7. we should follow-up chronic meningitis patients chronically.
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