Bazin C
Service de réanimation médicale Maladies infectieuses, parasitaires et tropicales Centre hospitalier régional et universitaire, Caen.
Rev Prat. 1994 Oct 15;44(16):2214-9.
The incidence of tuberculosis has been increasing since 1985. Favourable host factors associated with non specific neurologic abnormalities must lead to the hypothesis of a meningeal tuberculosis. Blood analysis and radiological findings rarely contribute to the diagnosis. The diagnosis is established when tubercle bacilli are identified in the cerebral-spinal-fluid, sometimes immediately but most often after 4 to 6 week culture. New faster methodes are being developed, but they are not yet routinely available. The treatment must be started before the identification of the tubercle bacilli. Usually, for immunocompetent patient, short-course treatment is chosen, consisting of an initial 2-month intensive treatment (rifampycin, isoniazid, and pyrazinamide) followed by a 4-month maintenance therapy with isoniadid and rifampicin, ethambutol should be included systematically during the first 16 weeks in prevention of isoniazid resistance.
自1985年以来，结核病的发病率一直在上升。与非特异性神经异常相关的有利宿主因素必然会引发结核性脑膜炎的假说。血液分析和影像学检查结果对诊断的帮助很少。当在脑脊液中发现结核杆菌时即可确诊，有时可立即确诊，但大多数情况下是在培养4至6周后确诊。新的更快的检测方法正在研发中，但尚未常规应用。必须在确定结核杆菌之前就开始治疗。通常，对于免疫功能正常的患者，会选择短程治疗，包括最初2个月的强化治疗（利福平、异烟肼和吡嗪酰胺），随后用异烟肼和利福平进行4个月的维持治疗，在最初的16周内应系统性地加入乙胺丁醇以预防异烟肼耐药。
