title: New times for an old disease: intracranial mass lesions caused by Mycobacterium tuberculosis in 5 HIV-negative African immigrants.
abstract: BACKGROUND
  The tuberculosis epidemic is still a global emergency, and its spread in the past 20 years has been fueled by the acquired immune deficiency syndrome pandemic and increasing drug resistance. International travel and migration may increase the incidence of tuberculosis in industrialized countries.
  
  
  METHODS
  We reviewed the clinical charts of patients admitted to the infectious diseases unit of Ospedali Riuniti (Bergamo, Italy) to identify patients with intracranial mass lesions caused by Mycobacterium tuberculosis.
  
  
  RESULTS
  During the past 6.5 years, 5 of 30 patients with a mass of infectious origin in the brain had tuberculous brain lesions diagnosed. All 5 were human immunodeficiency virus (HIV)-negative adults and African immigrants. No patient had concomitant meningitis, 1 had a concomitant pulmonary disease, and 3 subjects reported a past history of tuberculosis. At presentation, no patient had fever and 3 had seizures. Examination of cerebrospinal fluid revealed normal findings for 4 of 4 subjects, and neuroimaging showed multiple intracranial mass lesions in 4 of 5 patients. The diagnosis was definite for 2 subjects (based on analysis of brain specimens) and presumptive for 3 subjects (1 had concomitant pulmonary tuberculosis, and 2 had clinical response to therapy). Results of susceptibility tests for M. tuberculosis were available for 2 patients: both isolates were resistant to isoniazid, and 1 was also resistant to streptomycin. Duration of medical treatment ranged from 11 to 23 months, and 2 subjects underwent surgical procedures at the time of diagnosis. All 5 patients recovered.
  
  
  CONCLUSIONS
  Clinicians in western countries should consider the possible role of tuberculosis in causing mass lesions in the brain, particularly in immigrants from regions where tuberculosis is endemic.
authors.affiliation: Division of Infectious Diseases, Ospedali Riuniti, Bergamo, Italy. diego.ripamonti@tiscali.it
authors.forename: Diego
authors.initials: D
authors.lastname: Ripamonti
authors.forename: Regina
authors.initials: R
authors.lastname: Barbò
authors.forename: Marco
authors.initials: M
authors.lastname: Rizzi
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Finazzi
authors.forename: Laura
authors.initials: L
authors.lastname: Ravasio
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bonaldi
authors.forename: Fredy
authors.initials: F
authors.lastname: Suter
mesh_terms: D000328:Adult; D000349:Africa; D001927:Brain Diseases / Q000175:diagnosis / Q000382:microbiology*; D004641:Emigration and Immigration; D005260:Female; D018023:HIV Seronegativity; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D014376:Tuberculosis / Q000150:complications / Q000175:diagnosis*