Tuberculous meningitis: New approach for an old disease

Abstract:

Tuberculous meningitis (TBM) is the most severe form of tuberculosis. It is an important cause of death and disease among both children and adults throughout the world, especially in developing countries. The prognosis is worse in patients with HIV, in patients with severe neurological impairment, in chronic cases, and in patients with a resistance to drugs. The disease's pathogenesis has not as yet been sufficiently understood. Despite progress achieved over the past decades, a diagnosis of TBM is difficult to reach in many cases, because there is not as yet any diagnostic test sufficiently sensitive, targeted and timely. The percentage of patients where a definitive diagnosis of TBM can be established is low. TBM diagnosis and treatment are a challenge for neurologists. There is no characteristic medical profile, which makes it difficult to reach a diagnosis. Systemic symptoms of infection by Mycobacterium tuberculosis (MT), along with meningeal signs, may be suggestive of tuberculous meningitis. HIV infection does not change how tuberculous meningitis is presented. In 80% of patients with TBM, symptoms appear at least one week before diagnosis. The time profile for the onset of TBM symptoms could be used to differentiate tuberculous meningitis from bacterial meningitis. The percentage of patients diagnosed as having tuberculous meningitis might increase if a molecular diagnostic test were applied. Hydrocephalus, pre-contrast hyperdensity-hyperintensity, basal leptomeningeal enhancement, obliteration of the basal cisterns, infarcts and tuberculomas are highly frequent findingson CT and MRI studies. The diagnostic approach is based on clinical criteria, laboratory test results, and image findings. TBM prognosis depends on the presence of HIV, resistance to drugs, abnormal CT or MRI, substantial rise of proteins in CSF and onset of antituberculosis treatment three days after admission to hospital. The need to reach a diagnosis and administer early antituberculosis treatment is very important to reduce death and improve the prognosis. Recently, a consensus in terms of clinical diagnostic, laboratory and imaging criteria have been defined and recommended for tuberculous meningitis to be used in future clinical research. ©2012 Nova Science Publishers, Inc. All rights reserved.

Año de publicación:

2012

Keywords:

Fuente:

scopus