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Clinical and paraclinical aspects of tuberculous meningitis in a hospital of infectious diseases, Iasi, Romania

Abstract number: 1733_1107

Luca C., Dorobat C., Mihalache D., Petrovici C., Nastase E., Nemescu R., Caliman-Sturdza O., Luca V.

Objectives: The aim of this study is presentation of tuberculous meningitis in the department of Iasi Infectious Diseases Hospital, where patients from all North-East Romania are attended to.

Materials and Method: We retrospectively studied the cases of tuberculous meningitis during 2005–2006 regarding clinical and laboratory methods of diagnosis. We used the classic laboratory methods together with new ones, the quantification of gamma-interferon in blood, in presence of M. tuberculosis specific antigens.

Results: A total of 58 patients (41 male [71%] and 17 female [29%]) were included. The mean age was 31 years (age range: 10 months–80 years) with 12 patients (21%) over 50 years old and 15 under 14 years old (26%). 15 (26%) patients had a history of tuberculosis. The clinical symptoms and signs on the admittance were compatible with tuberculous meningitis: consciousness alteration in 18 cases (31%), focal neurological signs in 11 cases (19%), paraplegia and/or hemiplegia in 7 cases (12%) and extra-neurological tuberculosis was associated in 32 cases (55%).

The patients fulfilled some of following diagnosis criteria: CSF (cerebrospinal fluid) pleocytosis (with <100 elements/mL for 15 cases, 101–300 elements/mL for 25 cases and >300 elements/mL for 17 cases); high CSF protein level (45 cases, 78%); low CSF glucose level (32, 55%); favourable response to antituberculous therapy and steroids (51 cases, 88%); and a mortality of 12% (7 cases).

Microbiological diagnosis was done through culture in CSF with positive results in 18 cases: 6 cases (10%) were with negative CSF cultures and 12 (21%) had positive M. tuberculosis CSF cultures and positive Quantiferon TB Gold results. Also, in 3 cases (5%) we had multidrug resistant strains of M. tuberculosis.

We used quadruple association of antituberculous drugs for treatment, with favourable response in 48 cases (83%) and with a mortality of 12% (7 cases). Sequels were present in 18 cases (31%), with: hydrocephalus in 10 cases (56%), arachnoiditis in 3 cases (16%) and tuberculomas in 5 cases (28%).

Conclusion: Tuberculous meningitis is still a very serious disease in Romania, with high morbidity and mortality, especially among children and elders. Early diagnosis should be considered to improve prognosis. This study indicates that a new and rapid diagnosis method is highly needed and improves the prognosis of tuberculous meningitis, shorting the time needed for an early and accurate treatment initiation.

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Subject:
Location: ICC, Munich, Germany
Presentation type:
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