Characteristics of central nervous system tuberculosis in a low-incidence country: a series of 20 cases and a review of the literature.
Central nervous system tuberculosis (CNS-TB) is a devastating manifestation of tuberculosis (TB) caused by the hematogenous spread of Mycobacterium tuberculosis. Here, I present a retrospective analysis of 20 CNS-TB cases in Israel, a country with a low incidence of TB over an 11-year period (2000-2010). Most of the cases were those of African migrants, with an increased prevalence in adult females and in those with HIV coinfections. Clinical manifestations were usually non-specific, and miliary infiltrates were rare. Lymphocytic meningitis was frequent with bacteriological confirmation in 50% of the cases. The yields of cerebrospinal fluid smear examinations were low (20%). Brain computed tomography revealed tuberculomas (45%) and hydrocephalus (15%). All patients received individual treatment on the basis of drug susceptibility patterns and adjunctive steroid therapy. However, 35% of the patients died within the first year and the mortality rate was strongly correlated to disease severity (90%), HIV coinfection (85%), and hydrocephalus (66%). Progress in new diagnostic tests and early treatment may improve the current high mortality and morbidity rates.
Pulmonary and Tuberculosis Department, Shmuel Harofe Hospital.
Bendayan
B
Daniele
D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D015994:Incidence; D007557:Israel / Q000453:epidemiology; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012189:Retrospective Studies; D013256:Steroids / Q000627:therapeutic use; D016019:Survival Analysis; D020306:Tuberculosis, Central Nervous System / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology*; D055815:Young Adult
D000893:Anti-Inflammatory Agents; D000995:Antitubercular Agents; D013256:Steroids