[Tuberculous meningitis in 8-year observation of the Department of Infectious Diseases and Neuroinfections of the Medical Academy in Białystok].
OBJECTIVE
Tuberculous meningitis (tbm), although comparatively rare, remains a serious clinical problem.


METHODS
We have analyzed medical records of patients with tbm diagnosis hospitalized in our Department in the years 1995-2002.


RESULTS
During that period 11 cases of tbm were diagnosed in the Department. Family contact with a person with diagnosed tuberculosis was revealed in 2 of them, previously treated pulmonary tuberculosis in 2 and active tuberculosis outside cns was diagnosed in 4. On admission 9 of the patients were unconscious. Neurologic abnormalities were present in all 11 patients, most commonly they were pathologic reflexes and cranial nerve abnormalities. Cerebrospinal fluid (csf) showed abnormalities in all patients, however, with a high variability of its parameters (cytosis: 12-4400 cells per microliters, protein concentration 52-482 mg/dL, low glucose concentration in 2 patients). CT scan revealed cns abnormalities (most typically hypodense foci and/or ventricular enlargement) in 5 patients. Microbiologic confirmation (M. tuberculosis growth from csf) was obtained in only 1 patient, despite intensive diagnostic efforts. The mean time from admission to proper diagnosis and start of antituberculous treatment was 9.9 days. Treatment effects were favorable (healing without serious neurologic sequelae) in 7 patients, permanent sequelae were observed in 3 and one patient died while in hospital.


CONCLUSIONS
Our data confirm the presence of serious difficulties in the diagnosis and treatment of tbm. A prompt diagnosis and quick start of empirical treatment remain the most important means of reducing the mortality and frequency of permanent sequelae associated with this form of meningitis.
Grygorczuk
Sambor
S
Klinika Chorób Zakaźnych i Neuroinfekcji, Akademia Medyczna, Wojewódzki Szpital Specjalistyczny im. K. Dłuskiego, ul. Zurawia 14, 15-540 Białystok.
Pancewicz
Sławomir
S
Zajkowska
Joanna
J
Kondrusik
Maciej
M
Hermanowska-Szpakowicz
Teresa
T
D000328:Adult; D000368:Aged; D003391:Cranial Nerves / Q000000981:diagnostic imaging / Q000503:physiopathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D014057:Tomography, X-Ray Computed; D014390:Tuberculosis, Meningeal / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology