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Tuberculous meningitis in adults: evaluation of 38cases

Abstract number: P584

Inal A.S., Kurtaran B., Candevir A., Tasova Y., Aksu H.S.Z.

Objective: Tuberculous meningitis (TM) as a marker of uncontrolled of tuberculosis in population is still a health problem in developing countries. The aim of this study is to determine epidemiologic, diagnostic, clinical features and outcome of TM in adults who were admitted in Cukurova University Hospital.

Methods: Thirty-eight patients treated in Infectious Diseases Department between January 1995 and December 2004 were investigated retrospectively.

Results: Of patients, 20 were male (52.6), and 18 (47.4) were female. Mean age of the cases was 29 (min 15, max 60, SD ±13). Diagnosis was confirmed by microbiological evidence (culture, polymerase chain reaction or acid fast stain positivity) in 15 cases (39.5%), by histopathological, radiological and clinical findings in 13 (34.2%), and through response to therapy in 10 (26.3%) of patients. Mycobacterium tuberculosis (MT) was recovered from clinical samples in 10 patients (26.3%), wheras acid fast stain positive only in 4 (10.5%) patients. Drug resistance were detected for 2 isolates from CSF (One resistant to both isoniazid and rifampicin, and another resistant to both ethambutol and rifampicin). Both patients who has resistant MT were recovered with sequela. The initial examination of cerebrospinal fluid (CSF) showed cell counts ranging from 10 to 1530 with mean cell count 263/mm3, mean protein level 227 mg/dl (min 16, max 700), mean lactate 6.4 mmol/L (min 2.2-max 11.3). Three (7.9%) of the patients were classified as stage I, 15 (39.5%) as stage II, and 20 (52.6%) as stage III according to their clinical findings. Overall, 5 (13.2%) of the patients had a full recovery, 25 (56.7%) had recovery with sequela and 8 (21.1%) fatal cases were observed. All deaths were associated with stage III. No patient had HIV infection and in 33 (86.8%) of the patients there were no evidence of underlying pathology. Three patient had diabetes melitus, one has Crohn disease and one was pregnant. All of the patients received four major antituberculous drug regimen for 3–4 months and then INH and RMP plus steroid around 4 weeks, except ones with resistant MT. The mean duration of therapy was 12 months. Hydrocephalus was evident in 16 patient (42.1%), and 5 (13.2%) of them required ventriculo-peritoneal shunt.

Conclusion: TM is still an important health problem with high mortality and cost and severe sequela even in adults in developing countries. Clinicians must be aware and administer promp terapy to reduce complications.

Session Details

Date: 16/05/2009
Time: 00:00-00:00
Session name: 19th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Helsinki, Finland, 16 - 19 May 2009
Presentation type:
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