Infektološki glasnik, Vol. 33 No. 2, 2013.
Izvorni znanstveni članak
Tuberculous meningitis in adults: results from a 12-year retrospective study
Božana Miklaušić
; Opća bolnica "Dr. Josip Benčević", Slavonski Brod, Hrvatska
Davorka Dušek
; Klinika za infektivne bolesti "Dr. Fran Mihaljević", Zagreb, Hrvatska
Rok Čivljak
; Klinika za infektivne bolesti "Dr. Fran Mihaljević", Zagreb, Hrvatska
Marina Oljača Pribanić
; Klinika za infektivne bolesti "Dr. Fran Mihaljević", Zagreb, Hrvatska
Miljena Copois
; Klinika za infektivne bolesti "Dr. Fran Mihaljević", Zagreb, Hrvatska
Siniša Skočibušić
; Klinika za infektivne bolesti, Sveučilišna klinička bolnica Mostar, MF Sveučilišta u Mostaru, Mostar, B i H
Ljiljana Žmak
; HZJZ, Odjel za dijagnostiku tuberkuloze, MF Sveučilišta u Zagrebu, Zagreb, Hrvatska
Vera Katalinić-Janković
; HZJZ, Odjel za dijagnostiku tuberkuloze, MF Sveučilišta u Zagrebu, Zagreb, Hrvatska
Bruno Baršić
; Klinika za infektivne bolesti "Dr. Fran Mihaljević", Zagreb, Hrvatska
Sažetak
Tuberculous meningitis (TBM) is one of the most severe forms of disease caused by bacteria from the Mycobacterium tuberculosis complex (MTBC) and an important cause of morbidity and mortality in adults and children. Despite advances in diagnostic neuroradiology and microbiology methods, the diagnosis of TBM is still based on epidemiological and clinical data as well as cerebrospinal fluid (CSF) findings.
Aim. To evaluate epidemiological, clinical, laboratory and neuroradiological characteristics of adult patients with TBM and to compare findings between groups of patients with etiological proven and unproven TBM.
Methods. Aretrospective analysis of medical records of adult patients treated at "Dr. Fran Mihaljević" University Hospital for Infectious Diseases in Zagreb in the period 2000–2011 was performed. The diagnosis was based on diagnostic criteria for TBM adopted in Cape Town (South African Republic) in 2009. The following data were analyzed: age, sex, comorbidity, clinical characteristics, CSF finding, time of treatment initiation and outcome. The statistical analysis was performed by using the SAS software, and statistically significant difference was determined with Fischer's exact test and Mann-Whitney test.
Results. Out of 42 patients, 25 were classified as proven (confirmed etiological diagnosis of MTBC), and 17 as etiologically undetermined (1 probable and 16 possible) TBM cases. All patients were older than 18 years of age, and 26 (62%) younger than 65 years of age, with no significant differences according to sex. By comparing the proven and unproven groups, we found no statistically significant difference among patients who were in contact or had a history of TB. HIV-infection was not recorded in any of the patients. Astatistically significant difference between the two groups was found in the severity of the clinical presentation, positive meningeal signs, pleocytosis and the number of mononuclear cells in the CSF. Neuroradiological methods revealed hydrocephalus in 10 (24%) patients, tuberculoma in 6 (14%), brain abscess in 3 (7%) and vasculitis in 2 (5%) patients. The average time from the onset of symptoms until the initiation of appropriate antimicrobial therapy was 19 (range 3–450) days. Mortality was 36%, with no statistically significant difference between the two groups.
Conclusion. Statistically significant differences were observed in the severity of clinical presentation, positive meningeal signs and CSF findings between proven and unproven TBM patients, probably because of the relation between positive microbiological findings with disease distribution, and consequently the severity of clinical presentation. Timely diagnosis and early initiation of appropriate antimicrobial therapy can significantly reduce the morbidity and mortality associated with this difficult and severe illness.
Ključne riječi
Tuberculosis; meningitis; tuberculous meningitis; diagnosis; treatment
Hrčak ID:
133425
URI
Datum izdavanja:
30.6.2013.
Posjeta: 3.087 *