Abstract
Introduction: Tuberculosis remains a major public health problem. The damage to the central nervous system is severe. We reported here two cases. Clinical Case 1: A 37-year-old female patient, naively Human Immunodeficiency Virus1 (HIV1)-positive with antiretroviral (ARV) treatment, hospitalized in the Internal Medicine department for altered consciousness in a febrile context. The clinical examination at admission noted a meningeal syndrome. Cytological analysis of the cerebrospinal fluid (CSF) revealed lymphocytic meningitis with 98% lymphocytes for 3634 leukocytes. CSF polymerase chain reaction (PCR) detected Mycobacterium tuberculosis DNA. She was put on anti-tuberculosis treatment. The immediate course was favourable, but a secondary worsening of the clinical picture was the cause of his death. Clinical Case 2: A 34-year-old male patient, naively HIV1-positive with ARV treatment. He is hospitalized in the Multi-Purpose Anaesthesia and Resuscitation Department of the CNHU HKM for altered consciousness in a feverish context. The clinical examination noted a meningeal syndrome. The cytological analysis of the CSF noted 184 leukocytes for 99% lymphocytes. The CSF PCR identified the DNA of Mycobacterium tuberculosis. He was put on anti-tuberculosis treatment. The evolution was marked by his death. Conclusion: The neuromeningeal localization of tuberculosis is a poor prognosis. Co-infection with HIV remains a potential deadly combination.
Highlights
Tuberculosis remains a major public health problem
The most common reasons for late diagnosis are: difficulties in accessing care in resource-limited countries; the presence of mild somatic symptoms wrongly attributed to systemic infection in the prodromal phase of the disease; and misinterpretation of cerebrospinal fluid (CSF) abnormalities wrongly attributing meningitis to a cause due to the difficulty of detecting mycobacterium tuberculosis in the CSF [7] [8] [9]
The polymerase chain reaction (PCR) technique by Gen Xpert is the only alternative to standard techniques [10]
Summary
Tuberculosis (TB) is common worldwide with nine million new cases and two million deaths annually [1]. Among the described extra-pulmonary forms of this condition, tubercular meningoencephalitis accounts for 5% to 15% of these locations [6] This localization of Mycobacterium tuberculosis infection remains a serious form because despite progress in anti-tuberculosis antibiotic treatment and resuscitation, most of time it always involves a life-threatening prognosis [6] [7]. This severity of the condition is secondary to the delay in the diagnosis and management. The polymerase chain reaction (PCR) technique by Gen Xpert is the only alternative to standard techniques [10]. The interest of this work is to make any clinician in charge of a patient presenting neurological symptoms aware of the systematic search for Mycobacterium tuberculosis in the CSF by the Gen Xpert technique in the endemic context of tuberculosis
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
