ATXN2 and its neighbouring gene SH2B3 are associated with increased ALS risk in the Turkish population

Expansions of the polyglutamine (polyQ) domain (≥34) in Ataxin-2 (ATXN2) are the primary cause of spinocerebellar ataxia type 2 (SCA2). Recent studies reported that intermediate-length (27–33) expansions increase the risk of Amyotrophic Lateral Sclerosis (ALS) in 1–4% of cases in diverse populations. This study investigates the Turkish population with respect to ALS risk, genotyping 158 sporadic, 78 familial patients and 420 neurologically healthy controls. We re-assessed the effect of ATXN2 expansions and extended the analysis for the first time to cover the ATXN2 locus with 18 Single Nucleotide Polymorphisms (SNPs) and their haplotypes. In accordance with other studies, our results confirmed that 31–32 polyQ repeats in the ATXN2 gene are associated with risk of developing ALS in 1.7% of the Turkish ALS cohort (p = 0.0172). Additionally, a significant association of a 136 kb haplotype block across the ATXN2 and SH2B3 genes was found in 19.4% of a subset of our ALS cohort and in 10.1% of the controls (p = 0.0057, OR: 2.23). ATXN2 and SH2B3 encode proteins that both interact with growth receptor tyrosine kinases. Our novel observations suggest that genotyping of SNPs at this locus may be useful for the study of ALS risk in a high percentage of individuals and that ATXN2 and SH2B3 variants may interact in modulating the disease pathway

RESTORATION OF THE ENDÜRLÜK CHURCH IN TALAS

Birçok medeniyete ev sahipliği yapmış olan ülkemizde, tarih ve kültür zenginliği, günümüze kadar ulaşabilen eserlerle kendini göstermektedir. Din ve kültür çeşitliliği; Türkiye'nin her yerinde bir tarih bırakmıştır. Kayseri ve çevresi 20. yüzyılın ortalarına kadar Rum, Ermeni ve Müslümanların birlikte yaşadığı bir şehir olmuştur. Talas Endürlük köyü mübadeleye kadar bir Rum köyü olmuştur. Lozan antlaşması gereği Endürlük'teki Rumlar Yunanistan'a gitmiş, Yunanistan'daki Türkler de buraya yerleştirilmiştir. Endürlük Kilisesi, ihmal ve bilinçsiz tahribata rağmen ayakta durmaya çalışmaktadır. Bu terkedilmişlik, bakımsızlık ve tahribatı engelleyerek, yapının sürdürülebilir korunmasını sağlayacak verilerin hazırlanması amacıyla Endürlük Kilisesi çalışma konusu olarak seçilmiştir. Tez kapsamında, bir dönemin Rum inancını ve şeklini, yapı tarzını açıklayan bir belge olan Endürlük Kilisesi'nin korunmasına yönelik belgeleme ve restitüsyon yapılmış, bu bilgi ve belgeler baz alınarak restorasyon projesi hazırlanmıştır. Tez konusu kiliseye ilişkin elde edilen özgün bulguların pek çok değişim ve bozulmaları bulunan benzer kilise yapılarının restorasyon çalışmalarına da veri teşkil etmesi beklenmektedir.In our country which has been a host for many civilizations, richness in historical and cultural aspects shows itself through works that are still extant. Kayseri and its environment have been a city in which Greeks, Armenians and Muslims lived together up to twentieth century. In accordance with Treaty of Lausanne Greek people in Endürlük went to Greece and Turkish people in Greece were ensconced to this area. Endürlük Church has been exerting an effort to stand despite negligence and unconscious destruction. Endürlük Church has been chosen as a study subject in order to prepare data which shall provide with sustainable conservation of the building by means of preventing this dereliction, dilapidation and destruction. In the scope of the Thesis documentation and restitution study oriented towards the preservation of Endürlük Church, which is a document expressing a period's belief and its form and the style of building, has been made; consequently the restoration Project was prepared taking these information and documents as base. It is also expected that original findings and suggestions obtained, relating to the church, which is the subject of the Thesis, shall constitute a data for the restoration studies of similar church buildings that are changed and deformed

İmmün yetmelikli hastalarda aşı ile korunabilen hastalıklara karşı önerilen aşı programlarının yeterliliğinin retrospektif olarak değerlendirilmesi

Amaç: Çalışmanın ana amacı retrospektif olarak immün yetmezlikli hastalarda aşı ile korunabilen hastalıklara karşı aşı öncesi ve sonrası immün yanıtı değerlendirmektir. İkincil amaçlar ise immün yetmezlikli hastalarda bağışıklama şemasının gözden geçirilmesi, aşılama programı hakkında ilgili klinisyenlerin algısını arttırmak ve bağışıklama alışkanlığının kazandırılmasıdır. Gereç ve Yöntem: Ege Üniversitesi Enfeksiyon Hastalıkları polikliniğine veya aşı polikliniğine 1 Ocak 2016-8 Ekim 2018 tarihleri arasında başvuran kemik iliği nakilli, böbrek nakilli ve HIV pozitif hastalar retrospektif olarak taranmıştır. Belirtilen hasta gruplarında pnömokok, hepatit B ve hepatit A aşısı uygulanan, aşı öncesi ve aşı sonrası serolojik testleri bulunan hastaların demografik özellikleri, immün yetmezlik durumu ve aşı yanıtları kaydedilmiştir. Aşı yanıtı ve aşı yanıtını etkileyen faktörler değerlendirilmiştir. Bulgular: Çalışma kapsamında değerlendirilen hasta sayısı 168'dir ( 25 kemik iliği nakilli, 15 böbrek nakilli ve 128 HIV pozitif). Organ nakilli hastalarda nakil sonrası aşı başlanma medyan süresi sırasıyla kemik iliği nakillilerde 7 ay, böbrek nakillilerde 26 aydır (p=0,010). Çalışma kapsamında değerlendirilen üç immüm yetmezlikli hasta grubunda pnömokok aşısı sonrası istatiksel anlamlı antikor titrelerinde artış saptanmıştır, sırasıyla kemik iliği nakillilerde p=0,001 ,böbrek nakillilerde p=0,036 ve HIV pozitif hastalarda p=000 olarak bulunmuştur. Hepatit B aşısı uygulanan 12 kemik iliği nakilli hastanın sekizinde (%66,6) aşı sonrası serokonversiyon görülmüştür. Böbrek nakilli 15 hastanın sadece beşine nakil öncesi hepatit B aşısı uygulanmıştı, nakil sonrası hepatit B aşısı ile ise altı hastanın ikisinde bağışıklık gelişmiştir. HIV pozitif olgularda CD4 sayısı ile bazal pnömokok antikoru ve aşı sonrası pnömokok antikoru arasında korelasyon saptanmamıştır. CD4 sayısı <350 hücre/mm3 olan olgularda aşı ile antikor yanıtı artanların oranı %81,8 iken, ≥350 hücre/mm3 olan olgularda % 84 saptanmıştır. CD4 sayısına göre pnömokok antikorundaki artış arasında istatiksel anlamlı ilişki saptanmamıştır (p=0,609). CD4 sayısının Hepatit B aşı yanıtına etkisi değerlendirildiğinde; CD4 sayısı <350 hücre/mm3 olan olgularda bağışıklık %56,3 oranında iken, CD4 sayısı350 hücre/mm3 olan olgularda bağışıklık oranı %88,7 saptanmıştır. CD4 sayısının ≥350 hücre/mm3 olması ile hepatit B aşısına bağışıklık yanıt istatiksel anlamlı olarak artmaktadır (p=0,008). HIV RNA düzeyi ile hepatit B aşısına yanıt arasında ilişki saptanmamıştır (p=0,35). Hepatit A aşısı uygulanan 48 HIV pozitif hastanın 46'sında (%95) aşı sonrası bağışıklık gelişmiştir. Sonuç: Çalışmamızın sonucunda tüm immünsupresif hasta gruplarında pnömokok aşı etkinliğinin gösterilmiş olması nedeniyle pnömokok aşısı immünsupresif hastalara uygulanmalıdır. Böbrek nakilli hastalarda nakil sonrası aşı yanıtı azaldığından bu hastaların nakil öncesi aşılanması önemlidir. HIV pozitif hastalarda CD4 sayısı ile pnömokok aşısına yanıt arasında ilişki gözlenmezken, CD4 sayısının hepatit B aşısına yanıtı etkilediği gösterilmiştir. İmmün yetmezlikli hastaların rehber önerileri doğrultusunda aşıları yapılmalıdır.Objective: Retrospective evaluation of before and after immune responses among the immunocompromised patients by the vaccination against vaccine-preventable diseases was themain objective of our study. Secondary objectives were to review the vaccination schedule of the immunocompromised patients, to increase the perception of the clinicians about vaccination program and to gain the vaccination habitude. Material and Method: Bone marrow transplanted, renal transplanted and HIV positive patients who were admitted to Ege University Outpatient or Vaccination Clinic between the dates of January 1st 2016 – October 8th 2018, were screened retrospectively. Patients in these group of diseases whose serological results were available before and after the vaccination against Pneumococcus, Hepatitis B and Hepatitis A, were recorded in the terms of demographic features, immune deficiency status and immune responses to vaccinations together with affecting factors. Results: Total number of 168 patients (25 bone marrow transplanted, 15 renal transplanted and 128 HIV positive) were included in this study. Median duration of the vaccination start for the bone marrow transplanted patients were recorded as 7 days and for the renal transplanted patiens as 26 months (p=0,010). According to our study results, there was statistically significant increase in antibody titers after the vaccination in all of the three immunecompromised patient groups which were found as p=0,001 for the bone marrow transplanted, p=0,036 for the renal transplanted and p=000 for the HIV positive patients, respectively.Seroconversation was seen in 8 out of 12 (66.6%) bone marrow transplanted patients after the Hepatitis B vaccination. Only 5 out of 15 renal transplanted patients had Hepatitis B vaccination before the transplantation and after the transplantation 2 out of 6 patients had immunisation via Hepatitis B vaccination. In HIV positive patients, there was no correlation between the CD4 titer with basal pneumococcal antibody titer and pneumococcal antibody titer after the vaccination. Antibody response rate via vaccination was 81.8% for the patients with CD4<350 cell/mm3 whereas 84% for the patients with CD4350 cell/mm3. The increase of pneumococcal antibody titers according to CD4 levels was not found as statistically significant (p=0,609). On the other hand, Hepatitis B antibody response rate via vaccination was 56,3% for the patients with CD4<350 cell/mm3 whereas 88,7% for the patients with CD4350 cell/mm3 which was found as statistically significant (p=0,008). There was no correlation between the HIV RNA levels and Hepatitis B vaccine response rate (p=0,35). 46 out of 48 (95%) Hepatitis A vaccinated HIV positive patients had the immunity after the vaccination. Conclusion: Pneumococcal vaccination should be done for immunocompromised patients according to our study results which shows the enough efficacy of vaccination in all group of these patients. Because of the decreasing vaccine response rates after the renal transplantation, it is important that these group of patients should be vaccinated before the transplantation. Although there was no relationship between the CD4 level and pneumococcal vaccine response in HIV positive patients, CD4 level was shown to affect the Hepatitis B vaccine response rate. Finally, vaccination should be performed according to guidelines for the immunocompromised patients

Kidney Transplant in a Human Immunodeficiency Virus-Positive Patient: Case Report of Drug Interactions

End-stage renal disease in the human immunodeficiency virus-positive population is increasing. Kidney transplant is the optimal therapy for this population rather than dialysis modalities if some criteria are met. These include undetectable plasma human immunodeficiency virus RNA, CD4 cell count over 200 cells/mu L, and the absence of any AIDS-defining illness. Here, we describe the first living-donor kidney transplant in a human immunodeficiency virus-positive recipient in Turkey. The patient, a 52-year-old male diagnosed as human immunodeficiency virus positive, was on antiretroviral therapy, which consisted of 400 mg twice daily darunavir, 100 mg/day ritonavir, and 50 mg/day dolutegravir. He had been negative for human immunodeficiency virus RNA for the past 3 years. The patient developed renal insufficiency without any known cause and started hemodialysis. A living donor transplant from his son was performed, and the patient received ATG Fresenius-S (Neovii Biotech, Rapperswil, Switzerland) induction and a maintenance immunosuppression therapy consisting of methylprednisolone, mycophenolate mofetil, and tacrolimus. There were no incidences of delayed graft function or acute rejection. Because of tacrolimus and ritonavir interaction, tacrolimus trough levels were too high. With tacrolimus withdrawn, tacrolimus trough level decreased to detectable levels 2 weeks later. Antiretroviral therapy was continued on the same dosage. At month 4 posttransplant, the patient's creatinine level was 1.01 mg/dL. At present, the patient has had no complications and no episodes of rejection. Kidney transplant is the most favorable replacement therapy for HIV-positive patients who are under controlled AIDS care with highly active antiretroviral therapy. However, drug interactions should be carefully evaluated

Is Colony Count Important in the Managements of Patients with Candiduria?

Introduction: Candiduria is a common problem encountered in hospitalized patients, especially in intensive care units. Detection of Candida spp. in a urinary culture could be a sign of colonisation or severe infection. Due to the lack of well-defined, standard criteria it is difficult to differentiate between colonisation and infection. In this study, the role of the number of colonies was investigated to differentiate between colonisation and infection in hospitalized patients with established candiduria according to urinary culture. Materials and Methods: Patients who had urine culture positive for yeasts between December 2013 and March 2015 in Ege University Hospital (n= 217) were prospectively followed up. The data were evaluated observationally. Patients’ age, sex, diagnosis, clinical signs, urinary catheterization, hospital stay, underlying illness, hospitalization in intensive care, presence of candidemia, use of antibiotics and antifungals were evaluated. Culture results were reported as number of colonies/mL through quantitative cultures of all urine samples included in the study. Candiduria patients receiving antifungal treatment targeting candiduria were classified as infected. The number of colonies was used both as scale type and categorical data classified into two groups through three cut-points (103, 104, 105 and higher) in the analyses. The colony counts of patients receiving treatment and without treatment were compared using t-test and ChiSquare test. The relationship between colony counts and treatment was examined according to the presence of a urinary catheher, hospitalization in an intensive care unit and the microbial agents identified. Logistic regression was used in multivariate analyses. Mean values are shown with their standard deviations. Results: Among the patients, 134 were female and 83 male with a mean age of 64.03 ± 17.85 (17-109). The mean duration of hospital stay was 14 ± 17 days (1-123 day). Urinary catheter was present in 139 (64.1%) of the patients and their mean catheterization duration was 13.12 ± 7.81 days (1-36). The most frequent agent was Candida albicans (n= 98) followed by Candida glabrata (n= 76), Candida tropicalis (n= 21), Candida kefyr (n= 9). Vaginitis in 32 patients and candidemia in 6 patiens were detected by concurrent cultures. Number of colonies was detected as 105 and above in 107 of the patients (49.3%), below 103 in 43 (19.8%). Among the patients, 127 (60.5%) received treatment. No statistically significant difference was found among patients receiving treatment and patients without treatment accoring to the presence or absence of a catheter, Candida albicans versus non-albicans Candida as the agent, the cut-points of the number of colonies. Candiduria related treatment rates of hospitalized patients with catheter were significantly higher than catheterized patients in ICUs. Conclusion: Despite being the first prospective study in Turkey, It has been concluded that the presence of a catheter of the number of colonies according to the Candida species cannot be used as indicators of infection

Kandidürili Hastalara Yaklaşımda Koloni Sayısının Önemi Var Mı?

Introduction: Candiduria is a common problem encountered in hospitalized patients, especially in intensive care units. Detection of Candida spp. in a urinary culture could be a sign of colonisation or severe infection. Due to the lack of well-defined, standard criteria it is difficult to differentiate between colonisation and infection. In this study, the role of the number of colonies was investigated to differentiate between colonisation and infection in hospitalized patients with established candiduria according to urinary culture. Materials and Methods: Patients who had urine culture positive for yeasts between December 2013 and March 2015 in Ege University Hospital (n= 217) were prospectively followed up. The data were evaluated observationally. Patients' age, sex, diagnosis, clinical signs, urinary catheterization, hospital stay, underlying illness, hospitalization in intensive care, presence of candidemia, use of antibiotics and antifungals were evaluated. Culture results were reported as number of colonies/mL through quantitative cultures of all urine samples included in the study. Candiduria patients receiving antifungal treatment targeting candiduria were classified as infected. The number of colonies was used both as scale type and categorical data classified into two groups through three cut-points (103, 104, 105 and higher) in the analyses. The colony counts of patients receiving treatment and without treatment were compared using t-test and ChiSquare test. The relationship between colony counts and treatment was examined according to the presence of a urinary catheher, hospitalization in an intensive care unit and the microbial agents identified. Logistic regression was used in multivariate analyses. Mean values are shown with their standard deviations. Results: Among the patients, 134 were female and 83 male with a mean age of 64.03 ;plusmn; 17.85 (17-109). The mean duration of hospital stay was 14 ;plusmn; 17 days (1-123 day). Urinary catheter was present in 139 (64.1%) of the patients and their mean catheterization duration was 13.12 ;plusmn; 7.81 days (1-36). The most frequent agent was Candida albicans (n= 98) followed by Candida glabrata (n= 76), Candida tropicalis (n= 21), Candida kefyr (n= 9). Vaginitis in 32 patients and candidemia in 6 patiens were detected by concurrent cultures. Number of colonies was detected as 105 and above in 107 of the patients (49.3%), below 103 in 43 (19.8%). Among the patients, 127 (60.5%) received treatment. No statistically significant difference was found among patients receiving treatment and patients without treatment accoring to the presence or absence of a catheter, Candida albicans versus non-albicans Candida as the agent, the cut-points of the number of colonies. Candiduria related treatment rates of hospitalized patients with catheter were significantly higher than catheterized patients in ICUs. Conclusion: Despite being the first prospective study in Turkey, It has been concluded that the presence of a catheter of the number of colonies according to the Candida species cannot be used as indicators of infection.Giriş: Kandidüri hastanede yatan, özellikle de yoğun bakım hastalarında yaygın görülen bir durumdur. İdrarda Candida üremesi kolonizasyonun veya ciddi infeksiyonun belirtisi olabilir. Henüz tanımlanmış kriterler olmadığından kolonizasyon ve infeksiyon ayırımı zordur. Bu çalışmada hastanede yatan ve idrarında Candida üreyen hastalarda koloni sayısının kolonizasyon ve infeksiyon ayrımındaki rolü araştırılmıştır.Materyal ve Metod: Aralık 2013-Mart 2015 tarihleri arasında Ege Üniversitesi Tıp Fakültesi Hastanesi'nde yatarken idrar kültüründe maya üremesi olan 217 hasta prospektif olarak izlendi. Elde edilen veriler gözlemsel olarak değerlendirildi. Hastalar yaş, cinsiyet, tanı, klinik, kateter varlığı, yatış süresi, altta yatan hastalıkları, yoğun bakımda yatış, kandidemi, antibiyotik ve antifungal kullanımı yönünden incelendi. Çalışmaya dahil edilen tüm idrar örneklerinin kantitatif kültürü yapılarak, kültür sonuçları koloni sayısı/mL cinsinden raporlandı. Kandidürisi olan hastalardan kandidüriye yönelik antifungal tedavi alanlar infeksiyon olarak kabul edildi. Analizlerde koloni sayısı hem ölçüm tipi veri olarak kullanıldı, hem de 103, 104, 105 ve üstü olarak üç farklı kesim noktasından ikişer gruba sınıflandırıldı. Tedavi alan ve almayanlar koloni sayısı açısından t testi ve Ki-kare testi ile karşılaştırıldı. Koloni sayısı ve tedavi verilmesi arasındaki ilişki üriner kateter varlığı, yoğun bakım yatışı ve üreyen etkenler bazında incelendi. Çok değişkenli analizlerde lojistik regresyon kullanıldı. Ortalamalar ± standart sapmalarıyla ve (minimum-maksimum) değerlerle gösterildi.Bulgular: Hastaların 134'ü kadın 83'ü erkek, yaş ortalaması ise 64.03 ± 17.85 yıl idi. Hastaların ortalama hastanede yatış süresi 14 ± 17 gün (1-123 gün), 139 (%64.1)'unda üriner kateter mevcuttu, ortalama kataterizasyon süresi 13.12 ± 7.81 gündü. Etken olarak en sık Candida albicans (n= 98) idi. Bunu sırasıyla Candida glabrata (n= 76), Candida tropicalis (n= 21), Candida kefyr (n= 9) izledi. Eş zamanlı kültürlerle 32 hastada vajinit, 6 hastada kandidemi saptandı. Hastaların 107 (%49.3)'sinde koloni sayısı 105 ve üzeri, 43 (%19.8)'ünde koloni sayısı 103 saptandı. Hastaların 127 (%60.5)'sine tedavi verilmişti. Üriner kateter varlığında ve yokluğunda, C. albicans ve albicans dışı Candida'ların etken olması durumunda, tedavi alan ve almayan hastalar arasında koloni sayılarının kesme noktalarında istatistiksel olarak anlamlı bir fark saptanmadı. Kandidüri nedeniyle tedavi verilme oranı serviste yatan ve kateteri olan hastalarda, yoğun bakımda yatan ve kateteri olan hastalara göre istatistiksel olarak anlamlı bir şekilde yüksekti.Sonuç: Bu çalışma, ülkemizde prospektif gözleme dayalı olarak planlanan ilk çalışmadır. Kandidürili hastalarda sonda varlığının ve Candida türüne göre koloni sayılarının infeksiyon göstergesi olarak etkili olmadığı düşünülmüştür

HASTA NEDEN İYİLEŞEMİYOR ? AKUT PÜRÜLAN MENENJİT NEDENİYLE YATIRILAN KRONİK MENENJİT OLGUSU!

Although the most common form of tuberculosis is pulmonary tuberculosis, tuberculosis meningitis is associated with the highest mortality and morbidity. The major reasons of this, are insidious onset of disease and late diagnosis due to atypical presentation compared to bacterial meningitis. The coexistence of tuberculosis meningitis and acute bacterial meningitis is a rare clinical condition. In this paper, a 33-year-old female patient who was hospitalized due to acute purulent meningitis and diagnosed as tuberculosis meningitis was presented. After the lumbar puncture of the the patient who had complaints of nausea, vomitting, agitatiton and fever, Gram-positive diplococci were seen and ceftriaxone was started with diagnosis of pneumococcal meningitis. Although clinical improvement was seen at the beginning of the follow up, further detailed examination was performed due to the repeating complaints of fever and headache but no pathology was detected except meningitis. Because of the regression of the abnormal CNS results, conversive attack was considered but tuberculous meningitis was diagnosed with CNS culture positivity for Mycobacterium tuberculosis complex.The quadruple antituberculosis treatment was started. After two month, antibiotic susceptibility tests revealed sensitivity to tuberculous drugs and treatment was continued with isoniazid and rifampicin. Treatment of the patient still continues as an outpatient. Especially in countries which have relatively high tuberculous incidence like Turkey, tuberculous meningitis should be considered with the symptoms of headache, fever for long period, neurological involvement and acute bacterial meningitis clinic with inadequate response to treatment.Tüberkülozun en sık görülen formu akciğer tüberkülozu olmasına rağmen, mortalite ve morbiditesi en yüksek olan formu tüberküloz menenjitidir. Yüksek mortalite ve morbiditeye yol açmasının en önemli nedenleri bakteriyel menenjite göre daha sinsi başlangıç göstermesi ve atipik bulgularla seyretmesinden dolayı tanısının gecikmesidir. Tüberküloz ve bakteriyel menenjit birlikteliği çok nadir görülen bir klinik tablodur. Bu yazıda otuz üç yaşında akut pürülan menenjit nedeniyle yatırılan ve tüberküloz menenjiti saptanan bir kadın hasta sunulmuştur. Bulantı, kusma, ajitasyon ve ateş yüksekliği ile başvuran hastanın yapılan lomber ponksiyonunda Gram pozitif diplokok görülmesi üzerine pnömokok menenjiti tanısı ile seftriakson başlanmıştır. Hastanın takibinde önce klinik yanıt alınmasına rağmen ateş yüksekliği, baş ağrısının tekrar gelişmesi ve kliniğinin kötüleşmesi üzerine ayrıntılı inceleme yapılmış ancak menenjit dışında patoloji saptanmamıştır. Beyin omurilik sıvısı (BOS) laboratuvar bulgularında gerileme olduğundan dolayı konversif atakta olabileceği düşünülmüş ancak takibinde BOS’ta Mycobacterium tuberculosis kompleks üremesi saptandığı için tüberküloz menenjiti tanısı konulmuştur. Hastaya dörtlü antitüberküloz tedavisi başlanmıştır. Duyarlılık testi sonucu antitüberküloz ilaçlara duyarlı olarak sonuçlanmış ve tedaviye izoniyazid ve rifampisin ile devam edilmiştir. Tedavisi devam eden hasta poliklinik takibindedir. Özellikle ülkemiz gibi tüberküloz insidansının yüksek olduğu ülkelerde baş ağrısı, uzun dönemdir devam eden ateş yüksekliği, nörolojik semptomlar ve tedaviye yeterli yanıt vermeyen akut bakteriyel menenjit kliniğindeki hastalarda da tüberküloz menenjiti akla gelmelidir