title: Tuberculosis meningo-encephalitis with positive csf for KB and slowly favourable evolution. Case report.
abstract: BACKGROUND
  Meningoencephalitis produce by Koch bacillus is a disease including various symptoms, with often atypical onset and evolution, and with an etiological diagnosis being rarely established. It therefore remains a disease with severe prognosis, despite adequate treatment.
  
  
  METHODS
  a 47 years old male from Neamt County, with chronic otitis in his recent medical history, comes to the emergency room for fever, severe headache, confusion, equilibrium disorders, influenced health status, and meningeal irritation signs. Given his otitis and antibiotic therapy received in recent medical history, the patient was initially diagnosed and treated for beheaded bacterial meningitis (348 elements/mm3, 89% lymphocytes, 5% granulocytes, proteinorrhachia 1.54 g/l). Clinical and paraclinical evolution was poor with persistent fever and headache, impaired mental state, and the spinal puncture showed increased pleocytosis (725 elements/mm3), lymphocytosis (78%), increased proteinorrhachia (2.12 g/l), and low levels of glycorrhachia and chlorurorrhachia. Tuberculosis meningoencephalytis was suspected (confirmed after 3 weeks through cultures on Lowenstein-Jensen medium: positive for Mycobacterium tuberculosis), and a tuberculostatic treatment associating four drugs and intravenous Ciprofloxacin was started. Although the treatment included substances against cerebral edema and neurotrophic agent, his evolution showed persistent headache syndrome. We noticed very slow decrease in CSF pleocytosis (after a month) of treatment the patient still had 240 elements/mm3, 85% lymphocytesand 15% granulocytes. Moreover, due to hepatic toxicity a reduction of the tuberculostatic doses was needed.
  
  
  CONCLUSIONS
  The beginning of the tuberculosis infection symptoms is often surprising, with clinical signs regarding secondary determinations (meningoencephalitis) association with another infection (otitis--wrong diagnosis). as well as persistent yet slowly favorably evolving symptoms, both clinically and paraclinically (CSF parameters). The etiological agent is extremely rarely isolated, due to a very slow growth of the Koch bacillus on special culture mediums and also because such diagnosis is not often considered before starting the treatment.
authors.affiliation: Discipline of Infectious Diseases, University of Medicine and Pharmacy Grigore T. Popa-Iasi School of Medicine.
authors.forename: M E
authors.initials: ME
authors.lastname: Hurmuzache
authors.forename: Cătălina
authors.initials: C
authors.lastname: Luca
authors.forename: Irina
authors.initials: I
authors.lastname: Lovin
authors.forename: Carmen
authors.initials: C
authors.lastname: Dorobat
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use; D002555:Cerebrospinal Fluid / Q000187:drug effects / Q000382:microbiology*; D057210:Delayed Diagnosis; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D011379:Prognosis; D013997:Time Factors; D016896:Treatment Outcome; D020306:Tuberculosis, Central Nervous System / Q000175:diagnosis; D014390:Tuberculosis, Meningeal / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000188:drug therapy; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis
chemical_list: D000995:Antitubercular Agents