Abstract
IntroductionTuberculous meningitis (TBM) the most fatal presentation of tuberculosis (TB) especially in HIV-infected patients is a real diagnostic and therapeutic challenge worldwide. In Cameroon where HIV and TB are amongst the leading public health problems, the magnitude of TBM has not been defined. Therefore, the objective of this cross sectional study was to describe the presentation and in-hospital outcome of TBM among HIV patients in Douala as well as its diagnostic difficulties.MethodsWe did a clinical case note analysis of all HIV-1 infected patients treated for TBM in the Internal medicine unit of the Douala General Hospital, between January 1st 2004 and December 31st 2009. The diagnosis of TBM was made using clinical, laboratory [cerebrospinal fluid (CSF) analysis] and/or brain computerised tomographic (CT) scan features.ResultsDuring the study period, 8% (54/672) of HIV-infected patients had TBM. Their mean age was 40.3 ± 12.7 years. The main presenting complaint was headache in 74.1% (40/54) of patients. Their median CD4 cell count was 16 cells/mm3 (IQR: 10 – 34). CSF analysis showed median protein levels of 1.7 g/l (IQR: 1.3 – 2.2), median glucose level of 0.4 g/l (IQR: 0.3 – 0.5) and median white cell count (WCC) count of 21 cells/ml (IQR: 12 – 45) of which mononuclear cells were predominant in 74% of CSF. Acid fast bacilli were found in 1.9% (1/54) of CSF samples. On CT scan hydrocephalus was the main finding in 70.6% (24/34) of patients. In hospital case fatality was 79.6% (43/54).ConclusionTBM is a common complication in HIV-infected patients in Douala with high case fatality. Its presumptive diagnosis reposes mostly on CSF analysis, so clinicians caring for HIV patients should not hesitate to do lumbar taps in the presence of symptoms of central nervous system disease.
Highlights
Tuberculous meningitis (TBM) the most fatal presentation of tuberculosis (TB) especially in HIVinfected patients is a real diagnostic and therapeutic challenge worldwide
We decided to describe the clinical and radiological features of HIV-infected patients admitted to the Douala General Hospital with a presumed diagnosis of TBM, their outcome on treatment as well as the diagnostic difficulties associated with TBM
All patients had a lumbar tap (LP) done for cerebrospinal fluid (CSF) analysis and pre-LP computerised tomographic (CT) scan was done in 62.9% (34/54) of patients
Summary
Tuberculous meningitis (TBM) the most fatal presentation of tuberculosis (TB) especially in HIVinfected patients is a real diagnostic and therapeutic challenge worldwide. TBM usually results from haematogenous spread of primary or post primary pulmonary infection or from the rupture of sub-ependymal tubercle into the subarachnoid space [12] Meningeal involvement in this case mostly is non-specific making suspicion and diagnosis difficult. With the low scale up and low access to antiretroviral therapy [14], most HIV-infected patients still present with severe immune depression a higher risk of TBM. In this light, we decided to describe the clinical and radiological features of HIV-infected patients admitted to the Douala General Hospital with a presumed diagnosis of TBM, their outcome on treatment as well as the diagnostic difficulties associated with TBM
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