Cerebral abscesses of tuberculosis origin: study of 8 cases at the University Hospital of Conakry

Barry Louncény Fatoumata,Cissé Amara,Camara Mamadi,Barry Souleymane Djigué,Atakla H Ghislain,Barry Mamoudou,Cissé Fodé Abass,Donzo Ansoumane,Youla Sény,Djibo Hamani A Bachir,Barry Ibrahima Sory,Souare Ibrahima Sory,Ibrahima Sory Souaré,Condé Alpha Youssouf

doi:10.1186/s41984-020-00090-x

Barry Louncény Fatoumata, Cissé Amara + Show 12 more

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https://doi.org/10.1186/s41984-020-00090-x

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Abstract

IntroductionTuberculosis of the central nervous system (CNS) remains endemic in developing countries with high morbidity and mortality despite advances in imaging and treatment. The objective of our work was to describe the diagnostic and therapeutic difficulties of this pathology in the context of a country with limited health resources.Materials and methodsWe retrospectively studied 8 cerebral tuberculosis abscess files, collected in the archives of the neurosurgery department of the Conakry University Hospital over a 5-year period (January 2013–December 2017). The diagnosis was made by scanning and by isolation of acid-fast bacilli (AFB) by direct examination of pus.ResultsMean age was 33 years (9–56 years), sex, 5H 5 men/3F 3 women. History of pulmonary TB, 3 cases; TB contagious, 5 cases; TST ITR positive, 5 cases; associated visceral TB, 5 cases; HIV positive serology, 2 cases. The clinic was dominated by altered consciousness, 7 cases; focal signs, 7 cases; and fever, 5 cases. The site was hemispherical in 7 cases and one case in the posterior brain fossa. Treatment was medico-surgical in all patients. The evolution was favorable in 3 cases, the neurological sequelae in 3 cases, 2 cases of death, and 2 cases of recurrence.ConclusionCerebral tuberculous abscesses constitute a medico-surgical emergency. Despite their rarity, morbidity and mortality remains high in the context of developing countries due to diagnostic and therapeutic delays.

Highlights

Tuberculosis of the central nervous system (CNS) remains endemic in developing countries with high morbidity and mortality despite advances in imaging and treatment
We report our experience in order to describe the diagnostic and therapeutic difficulties of this pathology in the context of a country with limited health resources
All our patients benefited from a complete clinical examination, a standard check-up, cerebral CT scan, chest X-ray, and direct examination of pus with Ziehl-Neelsen staining for mycobacteria after puncture of the abscess

Summary

Introduction

Tuberculosis of the central nervous system (CNS) remains endemic in developing countries with high morbidity and mortality despite advances in imaging and treatment. Tuberculosis, caused by Mycobacterium tuberculosis, remains a hot topic around the world It is a major public health problem in developing countries, where it remains common [1, 2]. Cerebral intraparenchymal tuberculosis accounts for 10–30% of intracranial expansive processes in developing countries [4,5,6] where it remains endemic and associated with high morbidity and mortality despite advances in imaging and treatment. We report our experience in order to describe the diagnostic and therapeutic difficulties of this pathology in the context of a country with limited health resources

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