Abstract
Central nervous system tuberculosis is the most severe form of extrapulmonary TB and it is associated with a substantial morbidity and mortality. To describe the demographic profile, clinical features, laboratory and imaging results of a cohort of adult patients with TBM (Tuberculous meningitis). This study encompasses a prospective analysis of all adult cases of TBM diagnosed from 1st January 2010 to 31st December 2011 in the Neurology unit 2, National Hospital of Sri Lanka. Consensus case definitions for TBM were used for clinical case classification and patients were given a definite, probable, or possible tuberculous meningitis status accordingly. A total of 89 patients fulfilled the established diagnostic criteria for TBM and there were 22 definitive cases, 46 probable cases and 21 possible cases. The mean age of the series was 44 years and 56 (63%) were males. TBM presented with fever in 64 (71%), general constitutional symptoms in 61 (68%), headache in 53 (59%), and diminished level of consciousness in 36 (40%) patients. CSF biochemistry revealed elevated protein in all patients. MRI brain showed meningeal enhancement in 73 (82%). Twenty four (27%) died during hospitalisation and out of 65 who survived 44 (49%) had residual sequelae at the time of discharge. MRI evidence and biochemical analysis of CSF are still the main supportive diagnostic modalities. TBM is a relatively common but difficult to diagnose disease, which results in significant morbidity and mortality.
Highlights
Central nervous system tuberculosis is the most severe form of extrapulmonary TB and it is associated with a substantial morbidity and mortality
tuberculous meningitis (TBM) presented with fever in 64 (71%), general constitutional symptoms in 61 (68%), headache in 53 (59%), and diminished level of consciousness in 36 (40%) patients
TBM is a relatively common but difficult to diagnose disease, which results in significant morbidity and mortality
Summary
Central nervous system tuberculosis is the most severe form of extrapulmonary TB and it is associated with a substantial morbidity and mortality. In 2010, 9 million new cases and 1.5 million deaths related to tuberculosis were reported and of them 50% were tuberculous meningitis (TBM) [1]. Many studies have led to the frequent generalisation that 5-15% of individuals exposed to tuberculous bacilli will develop symptomatic disease [2]. Central nervous system (CNS) tuberculosis occurs in approximately 1% of all patients with symptomatic tuberculosis [2]. CNS tuberculosis (TB) could occur in the form of TB meningitis, milliary TB, parenchymal TB, tuberculomas or TB myelitis. In patients with TBM, neurological sequelae are common, and the case fatality rate has been estimated to vary from 15% to 60% [2]
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