Tuberculous meningitis. Short course of chemotherapy
F. Alarcon, L. Escalante, Y. Perez, H. Banda, G. Chacon and G. Duenas
Department of Neurology, Eugenio Espejo Hospital, Quito, Ecuador.
In March 1986, we began a 6-month short course trial of therapy for
tuberculous meningitis, in which 28 patients were analyzed. The diagnosis
was based on the following cerebrospinal fluid test results: in 53.5% of
the cases, Mycobacterium tuberculosis was identified by direct smear; in
57%, culture in Lowenstein-Jensen medium was positive; in 83.3%, the
detection of anti-bacille Calmette-Guerin (BCG) antibodies by enzyme-linked
immunosorbent assay was positive; and in 74%, the dosification of adenosine
deaminase activity was positive. In addition, in 21.4% of the cases, the
diagnosis was established by means of autopsy findings. Moreover, the
diagnosis was supported by bacteriological analyses from another tissue or
body fluids. Despite the administration of an antituberculous therapy,
32.4% of the patients died: all of the decreased had reached the last stage
of the disease by the beginning of treatment. Sixteen percent of the
patients who survived after more than 18 months of follow-up after therapy
had ended suffered neurological sequelae. With the 6-month therapeutic
regimen, the morbidity/mortality is similar to that found in the
longer-course therapies. The latter regimen is therefore thought to be a
good and acceptable therapeutic option for the treatment of tuberculous
meningitis.
