Meningeal tuberculosis: cases report years 2005-2017

Abstract

Background. Tuberculosis (TB) continues to be a global public health problem; its meningeal form leads to greater lethality and sequelae, particularly if it is associated with HIV / AIDS infection. Aim: To describe the demographic characteristics, clinical presentation, laboratory and images of patients with meningeal TB (isolation of Mycobacterium tuberculosis in CSF), analyzing differences between HIV and non-HIV patients. Methods: We performed an observational and descriptive study, with retrospective analysis of patients attending at the Dr. Alejandro Posadas Hospital, Buenos Aires, since January 2005 to December 2017. Results: Thirty-six patients were analyzed, with 22 women with a median age of 36.5 years. Twenty two patients had HIV coinfection, all in the AIDS stage. The symptom onset time was median 11 days. The predominant ones were fever, altered consciousness and headache. In the cerebrospinal fluid were lymphocitosis, hypoglycorrhachia, hyperproteinorrhachia and high lactic acid, according to previously described findings. Of 34 patients who underwent brain scan, 16 patients had no significant pathological findings. MRI was performed in 16 patients, 9 had vascular disorders. Brain MRI was more sensitive to identify meningeal reinforcement than computerized tomography, vascular disorders, and granulomatous lesions. The median onset of treatment was 1 day, with 72.2% of the total receiving coadjuvants with corticosteroids. Mortality of 27.7% and sequelae in 36.1% were observed. Only 5 patients required neurosurgical intervention. Conclusion: Since meningeal TB is a disease with high morbidity and mortality, it is imperative to ensure an early diagnosis in its evolution by incorporating molecular biology and imaging (MRI) into broad clinical use.