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Tuberculous meningitis in Denmark: a review of 50 cases

DOI: 10.1186/1471-2334-11-47

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Abstract:

A nationwide retrospective study was conducted, comprising all patients notified with tuberculous meningitis (TBM) in Denmark from 2000-2008. Medical records were reviewed using a standardised protocol.Fifty patients, including 12 paediatric patients, were identified. 78% of the patients were immigrants from countries of high tuberculosis endemicity. 64% of all patients had a pre-existing immunosuppressive condition; 10% were HIV positive, 48% were HIV seronegative and 42% had an unknown HIV status. Median symptom duration before admission was 14 days in the Danish patient population and 20 days in the immigrant group. Biochemical analysis of cerebrospinal fluid (CSF) samples revealed pleocytosis in 90% with lymphocyte predominance in 66%. Protein levels were elevated in 86%. The most common findings on neuro-radiological imaging were basal meningeal enhancement, tuberculomas and hydrocephalus. Lumbar puncture was performed on 42 patients; 31 of these specimens (74%) had a positive CSF culture for mycobacteria and 9.5% were smear positive for acid-fast bacilli. The overall mortality rate was 19% and 48% of the remaining patients had neurological sequelae of varying degree.TBM is a rare but severe manifestation of extrapulmonary TB in Denmark. The clinician must be prepared to treat empirically if the suspicion of TBM has arisen to improve treatment outcome.Tuberculosis (TB) of the central nervous system is the most severe manifestation of extrapulmonary TB and constitutes approximately 1% of all new cases annually [1]. Although the incidence of tuberculous meningitis (TBM) is low in high-income countries, it remains one of the most severe and eventually fatal infectious conditions - especially in times of increasing use of immunosuppressive drugs, increased access to transplantation (also for patients from TB endemic countries), changing HIV patterns and increasing prevalence of type II diabetes.TBM is characterised by a slowly progressing granulomatous inflammation

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