Abstract
The aim of the article is to describe the principal findings among patients with M.tuberculosis and M. bovis CNS infection. Mycobacterium tuberculosis is one of the most common infectious agents that cause death and neurological sequelae around the world. Most of the complications of CNS TB can be attributed to a delay in the diagnosis. Unfortunately, there are no specific diagnostic tools to support an early diagnosis. Other prognostic factors different from delay in treatment have not been identified. Clinical, radiological and laboratory characteristics were analyzed retrospectively from the medical files of all the patients admitted with the diagnoses of tuberculosis. Of 215 patients admitted with systemic tuberculosis, 64 (30%) had a neurological infection. Positive cultures were found in 54 (84%) cases, 18 (33%) in the CSF and the rest in other fluids or tissues. Adenosin deaminase (ADA) enzyme determination was more sensitive than M. tuberculosis PCR in the CSF for supporting an early diagnosis. In addition to a later clinical stage and treatment lag, positive CSF cultures (P=0.001) and the presence of M. bovis (P=0.020) were prognostic factors for a worse outcome. Neither older age, the presence of tuberculomas versus meningeal enhancement, or HIV co-infection, was associated to a worse prognosis. The isolation of M. bovis subspecies was more common that previously reported, and it was associated to the development of parenchymal lesions (P=0.032) when compared to M. tuberculosis. In this study, positive CSF cultures for M. tuberculosis and further identifying M. bovis species were additional prognostic factors for worse outcome. Positive cultures in systemic fluids other than CSF, even when the patient had no obvious systemic manifestations, and ADA determination in the CSF were noteworthy diagnostic tools for the diagnosis.
Highlights
Mycobacterium tuberculosis is one of the most common infectious agents that cause death and neurological sequelae around the world
In this study we aimed to identify the most common clinical, radiographic, and laboratory findings in patients with tuberculosis and central nervous system (CNS) involvement in the Mexican population, and we compared them to similar series from the literature
From 1999 to 2009, 215 patients were diag- patients had an MRI, and 51 patients had CT patients had new or enlarged cerebral lesions nosed with systemic tuberculosis; of them, 64 scan and MRI
Summary
Mycobacterium tuberculosis is one of the most common infectious agents that cause death and neurological sequelae around the world. In Mexico, there are 40,000 cases of active tuberculosis, and around 2500 cases are multi-drug resistant.[1] It is estimated that the central nervous system (CNS) is involved in 5-10% of the extra-pulmonary cases, Key words: CNS tuberculosis, tuberculous meningitis, M. tuberculosis, M. bovis. De Ciencias Médicas y Nutrición Salvador accounting for 1.3% of the total number of Acknowledgment: the authors would like to thank. México City, Mexico cases.[2] The diagnosis of CNS tuberculosis is to all the personal of the microbiology laboratory challenging, mostly because the initial symp- and especially to Miriam Bobadilla because withtoms may be identical to bacterial or viral out their work this manuscript would have not meningitis. Abstract receive multiple incorrect treatments, which may improve the symptoms temporary, but Contributions: the authors contributed
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