Tuberculous Meningitis in Adults in the Terms of Tertiary Prevention: Review of 22 Cases

DEAR EDITOR, High mortality due to tuberculous meningitis (TM) has been mentioned because of delayed diagnosis and treatment. A retrospective study was conducted on 22 admitted patients in Loghman Hakim hospital, Tehran, Iran, between October 2005 and August 2009. Tuberculous meningitis is defined as follows. Definite diagnosis of TM with presence of clinical meningitis signs (neck rigidity and abnormal cerebrospinal fluid [CSF] parameter) in addition to acid‐fast bacilli or tuberculosis‐polymerase chain reaction (TB‐PCR) positive in the CSF. Probable TM was considered when clinical meningitis signs were accompanied by at least one of following condition: (1) Suspected active pulmonary tuberculosis based on chest X‐ray, (2) acid‐fast bacilli found in any sample apart from the CSF, and (3) clinical evidence of other extra pulmonary tuberculosis. Possible TM was considered when clinical meningitis signs accompanied by at least four of the following: (1) A history of predominance of lymphocytes in the CSF, (2) duration of illness more than five days, (3) CSF/blood glucose ratio <0.5, low consciousness, yellow CSF, focal neurological signs, and (4) A good response to anti‐tuberculosis chemotherapy. A total of 18 men and 4 women with a mean age of 29.5 ± 13.5 (18‐73) were enrolled. Five (23%) Infectious Disease and Tropical Medicine Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran and The University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Australia, 1Shahid Beheshti University of Medical Sciences, Tehran, Iran Correspondence to: Prof. Zohreh Aminzadeh, Infectious Diseases Research Centre, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. E‐mail: [email protected]