Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
BMC Infect Dis. 2011 Feb 22;11:47. doi: 10.1186/1471-2334-11-47.
Tuberculous meningitis is the most severe manifestation of extrapulmonary tuberculosis with a high mortality rate and a high rate of sequelae among survivors. The aim of this study is to assess the current epidemiology, clinical features, diagnostic procedures, treatment and outcome in patients with tuberculous meningitis in Denmark, a country with a low tuberculosis incidence.
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.
结核性脑膜炎是肺外结核中最严重的表现形式，死亡率高，幸存者后遗症发生率高。本研究旨在评估丹麦结核性脑膜炎患者的流行病学、临床特征、诊断程序、治疗和预后，丹麦是一个结核病发病率较低的国家。
进行了一项全国性回顾性研究，纳入了 2000-2008 年丹麦所有确诊的结核性脑膜炎患者。使用标准化方案审查病历。
共发现 50 例患者，包括 12 例儿科患者。78%的患者为来自高结核病流行国家的移民。所有患者中 64%有预先存在的免疫抑制状况；10%为 HIV 阳性，48%为 HIV 阴性，42%为 HIV 状态未知。丹麦患者人群的入院前中位症状持续时间为 14 天，移民组为 20 天。脑脊液（CSF）样本的生化分析显示，90%的患者有白细胞增多，66%的患者以淋巴细胞为主。86%的蛋白水平升高。神经影像学最常见的发现是基底脑膜增强、结核瘤和脑积水。对 42 例患者进行了腰椎穿刺；31 例（74%）脑脊液标本培养有分枝杆菌阳性，9.5%的标本抗酸杆菌涂片阳性。总死亡率为 19%，其余患者中有 48%存在不同程度的神经后遗症。
结核性脑膜炎是丹麦肺外结核的一种罕见但严重的表现形式。如果怀疑结核性脑膜炎，临床医生必须准备进行经验性治疗，以改善治疗结果。
