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Abstract

Introduction: Tuberculosis is one of the most widely distributed infectious diseases in the world and meningeal tuberculosis is one of its most devastating manifestations. Its diagnosis and microbiological confirmation is not always easy.

Objective: To describe the experience in the diagnosis of meningeal tuberculosis by molecular tests compared with culture, characterizing the main clinical manifestations and determining factors associated with mortality.

Methods: We retrospectively identified adult patients diagnosed with meningeal tuberculosis, using molecular testing techniques and/or culture for M. tuberculosis, who were admitted to our institution between January 2018 and March 2020, a descriptive statistical analysis was performed. Pregnant women and patients who did not have a molecular test for M. tuberculosis were excluded.

Results: A sample of 33 patients was obtained, the most relevant findings in the cerebrospinal fluid (CSF) was the presence of hypoglycorrhachia, with a median of 34.2 mg / dl (IQR 2.0-95.0 mg / dl) and increased protein level, with a median of 265 mg / dl (IQR 24.0-600 mg / dl). The most significant result was the presence of elevated C-reactive protein in serum in all cases, with a median of 53.3 mg / L (IQR 22.9 - 89.6 mg / L) and neutrophilia in 75.8% (25). Mortality was 54.5% (18), the sensitivity for the molecular test in CSF was 38.46% and the positive predictive value 58.82%.

Conclusions: The diagnosis of meningeal TB remains a challenge, although molecular tests can help in early diagnosis, their sensitivity is low in extrapulmonary forms.