Tuberculous meningoencephalitis in HIV-seronegative patients: variety of clinical presentation and impact on diagnostics and treatment.
Tuberculous meningoencephalitis (TBM), an infrequent disease in Western European countries, shows a wide heterogeneity of clinical symptoms.


METHODS
We present 4 patients (age range 42-72 years) with the definite diagnosis of isolated TBM. All patients were HIV-seronegative, only 1 patient was known to be immunoincompetent on admission due to acute myelocytic leukemia; other reasons for immune suppression were detected in 2 other patients (leukemia and idiopathic CD4+ T-lymphocytopenia, respectively).


RESULTS
The diagnosis of TBM was confirmed in 3 cases by culture from CSF, in 1 case Mycobacterium tuberculosis was proven only in tracheal aspirate. In 1 patient M. bovis was found, which is an extremely rare cause of TBM in Germany. We report the contributions of different diagnostic tools (CSF analysis, neuroimaging) in reaching the presumptive diagnosis and in monitoring the further course. All patients developed neurological complications despite prompt tuberculostatic treatment. Three of the patients presented a chronic severe loss of consciousness of unclear origin.


CONCLUSIONS
The possible causative relationships of these complications and their impact on the prognosis are discussed.
Kassubek
J
J
Department of Neurology and Neurophysiology, University of Freiburg, Germany.
Zucker
B
B
Oehm
E
E
Serr
A
A
Arnold
S M
SM
Lücking
C H
CH
Els
T
T
D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001921:Brain / Q000473:pathology*; D004359:Drug Therapy, Combination; D004977:Ethambutol / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D018023:HIV Seronegativity; D006801:Humans; D007538:Isoniazid / Q000008:administration & dosage / Q000627:therapeutic use*; D008159:Lumbar Vertebrae / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011718:Pyrazinamide / Q000008:administration & dosage / Q000627:therapeutic use*; D012293:Rifampin / Q000008:administration & dosage / Q000627:therapeutic use*; D014390:Tuberculosis, Meningeal / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology
D000995:Antitubercular Agents; D011718:Pyrazinamide; D004977:Ethambutol; D007538:Isoniazid; D012293:Rifampin