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i
ADENOSINEDEAMINASE ACTIVITY INCEREBROSPINAL FLUID FOR DIAGNOSIS
OFTUBERCULOSIS MENINGITIS
By
Dr.RAMAKRISHNA
DissertationSubmittedtothe RajivGandhiUniversityofHealthSciences,Karnataka,Bangalore In partial fulfillment oftherequirementsforthe
degreeof 
DOCTOR OF MEDICINE
in 
GENERAL MEDICINE
Under the Guidance of 
Dr.RAVI KOBAL
M.D.
Professor
DEPARTMENT OF MEDICINEM.R. MEDICAL COLLEGE, GULBARGA-585 105MARCH 2006
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ii
 
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,KARNATAKA,
BANGALOREDECLARATION BY THE CANDIDATE
Iherebydeclarethatthisdissertation/thesisentitled 
“ADENOSINE DEAMINASE ACTIVITY INCEREBROSPINAL FLUID
FOR DIAGNOSIS OFT U B E R C U L O U S M E N I N G I T I S ”
isabonafideandgenuine researchworkcarriedoutbymeundertheguidanceof 
Dr.RAVIK O B A L
,Professor,DepartmentofMedicine.
Date: 
Place:GULBARGA
Dr.RAMAKRISHNA
 
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iii
 
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,KARNATAKA,
BANGALORECERTIFICATE BY THE GUIDE
This is to certify that the dissertation entitled 
“ADENOSINE DEAMINASE ACTIVITY INCEREBROSPINAL FLUID
FOR DIAGNOSIS OFT U B E R C U L O U S M E N I N G I T I S ”
isabonafideresearchwork doneby 
Dr.RAMAKRISHNA
in partial fulfillment of the requirementforthedegreeof 
DOCTOR OF MEDICINE
in 
GENERAL MEDICINE
.
Date: Place:GULBARGA
Dr.RAVI KOBAL
 
MD Professor Dept.ofMedicine,M.R.MedicalCollege,Gulbarga 
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iv
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,KARNATAKA,
BANGALOREENDORSEMENT BY THE HOD, PRINCIPAL/HEAD OF
THE INSTITUTION
This is to certify that the dissertation entitled 
“ADENOSINE DEAMINASE ACTIVITY INCEREBROSPINAL FLUID
FOR DIAGNOSIS OFT U B E R C U L O U S M E N I N G I T I S ”
isabonafideresearchwork doneby 
Dr.RAMAKRISHNA
undertheguidanceof 
Dr.RAVIK O B A L
,Professor,DepartmentofMedicine.
Dr.G.Veeranna,
MD, DM (Cardio)  
Dr.Mallikarjun B.
Prof.&HeadoftheDept.Principal Dept.ofMedicineM.R.MedicalCollege,Gulbarga 
 
Date: Date: 
Place:GULBARGAPlace:GULBARGA
 
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v
COPYRIGHTDECLARATION BY THE CANDIDATE
IherebydeclarethattheRajivGandhiUniversityof HealthSciences,Karnatakashallhavetherightsto preserve,useanddisseminatethisdissertation/thesis inprintor
electronicformatforacademic/research purpose.Date: 
Place: GULBARGA Dr.RAMAKRISHNA
 
©RajivGandhiUniversityofHealthSciences,Karnataka.
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ada in tb meningitis

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 OBJECTIVES
 REVIEW OF LITERATURE
 Table-1: Atypical Syndromes of Tuberculous Meningitis
 Table-2: Pharmacological profile of antituberculous drugs
 Table-3: Complications and Sequelae of Tuberculous Meningitis
 METHODOLOGY
 Table-4: Sex wise distribution of cases
 Figure-3: Sex wise distribution of cases
 Table-5: Age wise distribution of Cases

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Language:
English

ACKNOWLEDGEMENT
I realize that dissertation being a work of cooperation and assistance, it would be far from complete
without due acknowledgement of the help gratefully received.It is my distinct honour and privilege to
have under the able supervision of myteacher 
Dr.Ravi G.Kobal 
,
 
Professor, Department of Medicine, M.R. Medical College,Gulbarga. Indeed, I am fortunate to get the
benefit of his vast experience, valuableguidance and advise at every step of my study. It is with humble
gratitude, I payrespects and thanks to him for his keen interest in the study and guidance for
thepreparation of this dissertation.With a deep sense of gratitude I acknowledge the guidance rendered to
me by mybeloved teacher 
Dr.G.Veeranna
, M.D., D.M. (Cardio) Professor & Head of theDepartment of General Medicine. His proficient tutelage,
incessant guidance and immutable motivation actuated me to furnish an adept study.I thank my beloved
Professors
Dr.S.N.Alashetty, Dr.Anil Namoshi, Dr.P.S.Shankar,Dr.S.R.Harwal, Dr.B.A.Rudrawadi, Dr.Dilip
Rampure
and all my teachers in theDepartments of Medicine for their valuable suggestions.I am very much
thankful to all my seniors especially
Dr.Chaitanya Kumar, Dr.VivekPatil, Dr.R.Shashidhar, Dr.Mallindra Swamy, Dr.Guruprasad, Dr.Mainale,Dr.Anil
N.S.
, (PSM),
Dr.Sangappa K.
(Biochem0, and colleagues
Dr.Basangouda,Dr.Mallangouda, Dr.Rajith, Dr.Manjunath, Dr.S.S.S.Rao, Dr.Suresh Babu,Dr.Ratna
and 
Dr.M.A.Manohar
for their kind cooperation.I express my sincere gratitude to the Staff Members of 
I.C.C.U.
for their cooperationand help.I am grateful to my
Parents, Sisters & Brothers
for their unstinted support throughout my career.A special thanks to staff of Micro Computers, Gulbarga
for their excellent job of typing and binding of this dissertation in time.
Date: Place:Dr.Ramakrishna 
 
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vii
LIST OF ABBREVIATIONS USED
ADA................................Adenosine deaminaseAFB ................................Acid Fast
BacilliAIDS...............................Acquired immunodeficiency syndromeASPM..............................Aseptic
MeningitisAST.................................Aspartate amino transferaseATT ................................Antitubercular
TreatmentBCG................................Bacille Calmette GuerinCDC................................Centre for Disease
ControlCNS ................................Central Nervous SystemCPK ................................Creatinine
phosphokinaseCSF.................................Cerebrospinal fluid ELISA.............................Enzyme
linked Immunosorbent AssayESR.................................Erythrocyte sedimentation
rateHIV.................................Human immunodeficiency
virusINH.................................IsoniazidLDH................................Lactate
dehydrogenaseMAIC..............................Mycobacterium Avium
IntracellulareMDRTB ..........................Multidrug Resistant TuberculosisMRC ...............................Medical
Research CouncilPCR.................................Polymerase chain reactionPYOM.............................Pyogenic
MeningitisRIA .................................Radio Immuno AssaySIADH............................Syndrome of
Inappropriate ADHTBM................................Tuberculous Meningitis
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