Arzuaga J A, de la Fuente J, Tebas P, Pérez R, Masa C, Martínez J, de Letona M L
Servicio de Medicina Interna II, Universidad Autónoma, Madrid.
Enferm Infecc Microbiol Clin. 1992 Dec;10(10):576-80.
Tuberculous meningitis accounts for 5% to 12% of all extrapulmonary tuberculosis cases in western-hemisphere population non infected by HIV virus, and carries a high mortality rate.
We analyze retrospectively 21 patients with tuberculous meningitis in HIV negative patients seen from 1975 to 1989, with emphasis on clinical, laboratory and therapeutic features.
In 48% of cases there were not typical meningeal signs, and 61% of patients showed neurological focal signs and/or seizures. CSF examination revealed a clear fluid with high cell counts (mostly lymphocytes), high protein and low sugar levels in 67% of cases. However, the microbiologic examination had a low yield of diagnosis (33%). The clinical course is prolonged, and treatment is usually delayed. Morbidity and mortality were high (34% and 10% of cases). In this study, the use of steroids did not show a significant reduction in mortality nor in neurological sequelae.
Tuberculous meningitis in HIV negative patients is a chronic infection, without meningeal signs in most cases and linked to a high rate of neurological defects. The microbiologic tests have low yield of diagnosis. Steroid drugs seem to be indicated only if there are additional complications.
在西半球未感染艾滋病毒的人群中，结核性脑膜炎占所有肺外结核病例的5%至12%，且死亡率很高。
我们回顾性分析了1975年至1989年间收治的21例艾滋病毒阴性的结核性脑膜炎患者，重点关注其临床、实验室和治疗特征。
48%的病例无典型脑膜刺激征，61%的患者有神经定位体征和/或癫痫发作。脑脊液检查显示67%的病例脑脊液清亮，细胞计数高（主要为淋巴细胞），蛋白含量高，糖含量低。然而，微生物学检查的诊断阳性率较低（33%）。病程迁延，治疗通常延迟。发病率和死亡率较高（分别为34%和10%）。在本研究中，使用类固醇并未显著降低死亡率和神经后遗症的发生率。
艾滋病毒阴性患者的结核性脑膜炎是一种慢性感染，多数病例无脑膜刺激征，且神经功能缺损发生率高。微生物学检查诊断阳性率低。仅在有其他并发症时似乎才需要使用类固醇药物。
