Tuberculosis Meningo-encephalitis in Casablanca, Morocco

Neuromeningeal tuberculosis remains the most serious form of Mycobacterium tuberculosis infection. The wide clinical polymorphism and lack of specificity of radiological signs make diagnosis difficult and lead to delays in management.

To describe the epidemiological profile of confirmed Tuberculous Meningo-encephalitis.

This is a monocentric, retrospective, descriptive and analytical study of patients followed for confirmed tuberculous Meningo-encephalitis in Infectious diseases department at the Ibn Rochd University Hospital in Casablanca between January 2015 and December 2018. Analytical and multivariate logistic regression analyses were performed to identify predictors of mortality and neurological sequelae.

90 patients were included, 58% were male with an average age of 38 years. The main risk factors were low socioeconomic status (90%) and recent tuberculosis contact was observed in 13.3%. Onset of symptoms was progressive (92.2%) with average evolution of 25.4 days. Predominant clinical signs were fever (97.4%), headache (70%) and stiff neck (58%). Clinical forms were Meningo-encephalitis (59.9%) and meningitis (36.8%). Predominant Brain radiological sign was leptomeningeal contrast (35%). Cerebrospinal fluid (CSF) abnormalities: White cells mean: 128 white cells/mm3 with lymphocytic predominance (79.1%); Proteinorachia mean: 1.27g/l, Glycorrachia mean: 0.32g/l (88%). Culture on Lowenstein positive in 85% and RT- Polymerase Chain Reaction (PCR) performed in 17.7% and positive in 87.5%. All patients had received standard antituberculosis drugs combining Isoniazid, Rifampicin, Pyrazinamide and Ethambutol. Evolution was favorable with symptom resolution patient rate of 62.5%, 10% mortality, 7.8% neurological sequelae. In multivariate analysis, delayed diagnosis, hydrocephalus and Meningo-encephalitis form were independently associated with mortality or neurological sequelae.

Neuromeningeal tuberculosis in the form of tuberculous meningoencephalitis presents a clinical, biological and radiological polymorphism. Its prognosis depends on the earliness of the diagnosis and treatment.