[Tuberculous meningitis in patients without HIV infection. Presentation of 21 cases]

Tuberculous meningitis accounts for 5% to 12% of all extrapulmonary tuberculosis cases in western-hemisphere population non infected by HIV virus, and carries a high mortality rate.

We analyze retrospectively 21 patients with tuberculous meningitis in HIV negative patients seen from 1975 to 1989, with emphasis on clinical, laboratory and therapeutic features.

In 48% of cases there were not typical meningeal signs, and 61% of patients showed neurological focal signs and/or seizures. CSF examination revealed a clear fluid with high cell counts (mostly lymphocytes), high protein and low sugar levels in 67% of cases. However, the microbiologic examination had a low yield of diagnosis (33%). The clinical course is prolonged, and treatment is usually delayed. Morbidity and mortality were high (34% and 10% of cases). In this study, the use of steroids did not show a significant reduction in mortality nor in neurological sequelae.

Tuberculous meningitis in HIV negative patients is a chronic infection, without meningeal signs in most cases and linked to a high rate of neurological defects. The microbiologic tests have low yield of diagnosis. Steroid drugs seem to be indicated only if there are additional complications.