[Tuberculous meningitis: diagnosis and therapeutic difficulties].
Tuberculosis remains a public-health problem in 2010 with 9 millions cases and 1,7 million deaths worldwide each year. Tuberculosis meningitis is rare (0.5 to 1%) but is associated with high mortality and disability among survivors. An early starting of treatment is crucial. Despite molecular biology methods, microbiological diagnosis remains a challenge for the biologist. We report here 2 cases of tuberculous meningitis with different clinical and biological presentations, which underline diagnosis and therapeutic difficulties encountered in the management of this disease. The first one occurred in an HIV infected patient and the second one was caused by a multidrug-resistant strain. Clinical issues were severe with important neurological residual disability and death. Biological methods available for tuberculous meningitis diagnosis are exposed.
Janvier
Frédéric
F
Service de Biologie Médicale, Hôpital d'Instruction des Armées Bégin, Saint Mandé, Ecole du Val-de-Grâce, Paris. janvierfred@hotmail.com
Mérens
Audrey
A
Fabre
Michel
M
Delacour
Hervé
H
Pelletier
Christophe
C
Soler
Charles
C
Rapp
Christophe
C
Cavallo
Jean-Didier
JD
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D014390:Tuberculosis, Meningeal / Q000175:diagnosis* / Q000188:drug therapy*; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis
D000995:Antitubercular Agents