Tuberculosis of the central nervous system experienced at the International Medical Center of Japan

Abstract

In spite of recent advances in diagnosis and chemotherapy of tuberculosis, prognosis of tuberculosis of the central nervous system (CNS) is still poor. We evaluated clinical characteristics of 14 patients with the CNS tuberculosis (10 male and 4 female, 21 to 71 years of age) who were hospitalized at IMCJ from 1988 to 1997. Twelve patients had tuberculous meningitis (2 of them had also intracranial tuberculoma), 1 had intracranial tuberculoma and 1 had spinal cord tuberculosis. For the acid-fast bacilli, the smears of cerebrospinal fluids (CSF) were all negative but the cultures for M. tuberculosis were positive in 5. Using PCR method, M. tuberculosis was identified from CSF specimens in 2 out of 9 culture negative patients, thus suggesting the usefulness of the PCR for the rapid diagnosis of CNS tuberculosis. The adenosine deaminase (ADA) levels in CSF may provide another diagnostic clue because they were elevated in 8 out of 10 cases. It is to be noted that there were three patients who developed clinical manifestations of CNS tuberculosis after the initiation of chemotherapy for pulmonary tuberculosis. In the last five cases, four-drug regimen which included PZA, was used with a good result. The success could be related to the addition of PZA which penetrates blood-brain barrier just as good as INH. Two patients died and one remains unconscious with severe neurological sequelae. The present study indicates that positive CSF culture, hydrocephalus and consciousness disturbance are important factors in determining poor prognosis of the CNS tuberculosis.