A new approach to tuberculous meningitis in Spain

Abstract number: P588

Moreno V., Valencia E., Ramirez-Olivencia G., González Lahoz J.

Objectives: Tuberculosis (TB) is an increasing health problem in Spain due to immigrants and patients HIV+. Tuberculous meningitis (TM) is one of the most important manifestations and our objective was to analyse the characteristics and evolution of a group of Spanish and non-Spanish patients with TM.

Methods: We reviewed the clinical history of 25 patients with TM hospitalised (2002–2008). Statistical study was done by SPSS 13.0. A comparative study was performed of variables related to nationality.

Results: TB was only meningeal in 17 patients and disseminated with meningeal localisation in 8. In 10 cases there was a previous episode of TB and 20 (12 Spanish and 8 immigrants) were HIV+ (80%). Mean age was 43 years, 13 were men (52%) and 14 were Spanish (56%). The other were from Equatorial Guinea (20%), Ecuador (12%), Nigeria (8%) and Peru (4%). Fever and headache were the most frequent symptoms (96%), 17 patients (68%) had confusion and 14 were disorientated. The most important criteria for TM diagnosis were cerebrospinal fluid biochemical alterations with elevated cells (mean: 298 cells/mm3, all cases lymphocytes), elevated protein level (mean: 171 mg/dl), decreased glucose level (mean: 34 mg/dl) and elevated adenosine deaminase level (mean: 15 IU/L). Koch bacilli grew in sputum in 16%, in urine in 20% and in spinal fluid in 8%. All cases were sensible TB. 21 (84%) patients were treated with 4 drugs and 15 (60%) received dexamethasone. One year after treatment 17 patients were cured, 4 were dead (16%) and 4 left pursuit without finishing the treatment. Three subjects cured with major sequels. The use of dexamethasone did not influence evolution. Spanish patients were men most frequent than immigrants (71% vs 27%), heavy alcohol drinkers (50% vs 9%), smokers (79% vs 18%), intravenous drug users (71% vs 0%) and had more disseminated tuberculosis (43% vs 18%). None of immigrants patients had culture positive, all were treated with 4 anti-tuberculous drugs and there was no differences between clinical manifestations, presence of HIV infection, cerebrospinal fluid biochemical alterations or evolution.

Conclusions: TM is a very important health problem with an elevated number of sequels and mortality. Half of our patients were immigrants and 80% were co infected with HIV. The clinical and evolutionary characteristics of immigrants were comparable to Spanish patients but their demographic, microbiological ant treatment characteristics were different.