Analysis of Tuberculous Meningitis in Albacete (Spain)

Introduction: TBM is the most severe manifestation of extrapulmonary TB with a high mortality rate and high rate of secondary results among survivors. Cerebrovascular complications of TBM are common, and this may represent its most serious legacy. Objectives: The aim our study is to analyze the epidemiologic, clinic and laboratory features of patients with TBM in a regional hospital in Albacete (Spain). It is a retrospective study of TBM cases which were admitted to the General University Hospital Albacete, from 1991 to 2010. Results: 29 patients were diagnosed with TBM. The average age of the patients was 36.2 years of which 18 (62.1%) were males, 22 (75.9%) were adults, and 2 (6.9%) were nonnationals. Among the total patients, 4 patients were HIV-infected (13.8%). The most common clinical presentations were fever (79.3%) and headache (48.3%). CSF examinations showed increased protein and ADA levels, low glucose levels and lymphocytic pleocytosis in most cases. Corticosteroids were administrated to 75.9% of the patients. There were cases of brain stroke in 10 patients (34.5%). Other complications encountered were syndrome of inappropriate ADH secretion (SIADH) (41.4%) and hydrocephalus (13.8). Neurological sequelae were observed in 31% of the patients, and 3 patients (10.3%) died. Discussion: In our case study, lower mortality rates were observed than in other studies probably due to the adequate use of corticosteroids, early treatment and the lower rate of HIV-patients, whereas the percentage of cases with fever, SIADH, meningeal signs and brain strokes were similar as observed in other case studies. Conclusions: TBM is still a diagnostic problem. A high index of suspicion is required in order to make an early diagnosis and treatment.