Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain.
Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain.
Int J Infect Dis. 2020 Oct;99:62-68. doi: 10.1016/j.ijid.2020.07.041. Epub 2020 Jul 28.
Tuberculous meningitis (TBM) occurs in 1-5% of cases of tuberculosis. Without early treatment, mortality and permanent disability rates are high.
A retrospective study performed at a tertiary hospital in Madrid (Spain) to describe clinical, diagnostic, and therapeutic aspects of TBM and analyze epidemiological trends over forty years, divided into two intervals (1979-1998 and 1999-2018).
Overall, TBM was diagnosed in 65 patients (1.8% of new tuberculosis diagnoses), 48 in the first period and 17 in the second one. Median age at diagnosis increased from 38.5 to 77 years (p = 0.003). The proportion of non-HIV immunosuppressed patients increased (from 2.1% to 29.4%, p < 0.001), while the percentage of patients with a history of drug-abuse decreased (from 33.3% to 5.9%, p = 0.027). The median time between the onset of neurological symptoms and lumbar puncture increased from seven to 15 days (p = 0.040). The time between the onset of symptoms and the initiation of tuberculostatic treatment also increased from eleven to 18 days (p = 0.555). Results from image, biochemical, and microbiological tests showed no differences between both periods. A decreasing trend was observed in survival rates at 1-week (from 97.9% to 64.7%, p < 0.001), 1-month (from 91.7% to 58.8%, p = 0.002) and 1-year (from 85.4% to 47.1%, p = 0.002) after TBM diagnosis.
The profile of patients diagnosed with TBM has changed from a young HIV-infected patient with a history of drug addiction to an elderly patient with non-HIV immunosuppression. Diagnosis and start of treatment both experienced a noticeable delay in the second period, which could help explain the increase in mortality observed across the two periods.
结核性脑膜炎（TBM）在结核病患者中占 1-5%。如果不及时治疗，死亡率和永久性残疾率很高。
这是一项在马德里一家三级医院进行的回顾性研究，旨在描述 TBM 的临床、诊断和治疗方面，并分析四十年来的流行病学趋势，分为两个时期（1979-1998 年和 1999-2018 年）。
共诊断出 65 例 TBM 患者（新诊断结核病的 1.8%），其中 48 例在第一个时期，17 例在第二个时期。诊断时的中位年龄从 38.5 岁增加到 77 岁（p=0.003）。非 HIV 免疫抑制患者的比例增加（从 2.1%增加到 29.4%，p<0.001），而有药物滥用史的患者比例下降（从 33.3%下降到 5.9%，p=0.027）。从神经系统症状出现到腰椎穿刺的中位时间从 7 天增加到 15 天（p=0.040）。从症状出现到开始抗结核治疗的时间也从 11 天增加到 18 天（p=0.555）。两个时期的影像学、生化和微生物学检查结果没有差异。在 TBM 诊断后 1 周（从 97.9%下降到 64.7%，p<0.001）、1 个月（从 91.7%下降到 58.8%，p=0.002）和 1 年（从 85.4%下降到 47.1%，p=0.002）时的生存率呈下降趋势。
诊断为 TBM 的患者的特征已从年轻的 HIV 感染患者、有药物滥用史转变为老年非 HIV 免疫抑制患者。第二期的诊断和治疗开始都明显延迟，这可能有助于解释两个时期死亡率的增加。
