Hammami Fatma, Koubaa Makram, Chakroun Amal, Rekik Khaoula, Feki Wiem, Marrakchi Chakib, Smaoui Fatma, Jemaa Mounir Ben
MD, Infectious Diseases Department and Extra-pulmonary Research Unity, Hedi Chaker University Hospital, University of Sfax, 3029, Tunisia.
MD, Radiology Department, Hedi Chaker University Hospital, University of Sfax, 3029, Tunisia.
Germs. 2021 Mar 15;11(1):23-31. doi: 10.18683/germs.2021.1237. eCollection 2021 Mar.
Tuberculosis is a multisystem disease that may affect any organ or tissue. Tuberculous meningitis (TBM) is the most severe form of tuberculosis and commonly affects the brain. We aimed to study the epidemiological, clinical, therapeutic and evolutionary features of TBM among adults and to compare them with other forms of extrapulmonary tuberculosis.
We conducted a retrospective study including all patients hospitalized for extrapulmonary tuberculosis in the infectious disease department in Sfax, Tunisia between 1993 and 2018. We specified the particularities of TBM cases, and we compared them with other extrapulmonary tuberculosis cases.
We encountered 78 patients diagnosed with TBM, among 519 patients with extrapulmonary tuberculosis (15%). The median age was 36 years (23-50) years. There were 44 females (56.4%). In comparison with other forms of extrapulmonary tuberculosis, fever [odds ratio (OR)=4.4; p<0.001], asthenia (OR=3.4; p<0.001) and anorexia (OR=2.3; p=0.001) were significantly more frequent in TBM patients. Adverse effects of antitubercular therapy were more frequent among TBM patients (OR=3.1; p<0.001). The mean duration of antitubercular therapy was 15 (12-20) months. Recovery occurred in 66 cases (84.6%), complications in 44 cases (56.4%) and death in 7 cases (9%). Comparison of the disease evolution showed that complications (OR=7.4; p<0.001) and mortality rates (OR=10.7; p<0.001) were significantly more frequent in TBM patients, while recovery was significantly more frequent in other sites of extrapulmonary tuberculosis patients (OR=0.5; p=0.02).
In our country, TBM remains a disabling disease. Despite antitubercular therapy, the prognosis was more severe with the occurrence of not only complications but also a high mortality rate in comparison with other forms of extrapulmonary tuberculosis. When clinical and laboratory features suggest the diagnosis of TBM, clinicians should look for tuberculosis elsewhere in the body.
结核病是一种多系统疾病，可累及任何器官或组织。结核性脑膜炎（TBM）是结核病最严重的形式，通常影响脑部。我们旨在研究成人TBM的流行病学、临床、治疗及演变特征，并将其与其他肺外结核形式进行比较。
我们进行了一项回顾性研究，纳入了1993年至2018年期间在突尼斯斯法克斯传染病科因肺外结核住院的所有患者。我们明确了TBM病例的特殊性，并将其与其他肺外结核病例进行比较。
在519例肺外结核患者中，我们遇到了78例诊断为TBM的患者（15%）。中位年龄为36岁（23 - 50岁）。有44名女性（56.4%）。与其他形式的肺外结核相比，发热[比值比（OR）=4.4；p<0.001]、乏力（OR=3.4；p<0.001）和厌食（OR=2.3；p=0.001）在TBM患者中显著更常见。抗结核治疗的不良反应在TBM患者中更频繁（OR=3.1；p<0.001）。抗结核治疗的平均持续时间为15（12 - 20）个月。66例（84.6%）康复，44例（56.4%）出现并发症，7例（9%）死亡。疾病演变的比较表明，并发症（OR=7.4；p<0.001）和死亡率（OR=10.7；p<0.001）在TBM患者中显著更常见，而在其他肺外结核部位的患者中康复显著更常见（OR=0.5；p=0.02）。
在我国，TBM仍然是一种致残性疾病。尽管进行了抗结核治疗，但与其他形式的肺外结核相比，预后更严重，不仅会出现并发症，而且死亡率高。当临床和实验室特征提示TBM诊断时，临床医生应在身体其他部位寻找结核病灶。
