Tuberkulöse Meningoenzephalitis: klinisches Bild, Diagnostik und Behandlung

BACKGROUND: Tuberculous meningoencephalitis (TBM) is still associated with a high mortality. The relative rareness of TBM in Western European countries and the accompanying heterogeneous and unspecific clinical symptoms often result in a delayed diagnosis. PATIENTS AND METHODS: We present six HIV-negative patients (age 37-72 years) with a laboratory-confirmed or clinically probable diagnosis of TBM. The diagnosis could be confirmed in three patients by culture of the cerebrospinal fluid (CSF), in one patient by positive tracheal aspirate culture. In the cases with probable TBM, the diagnosis was confirmed by the combination of clinical symptoms, CSF analysis, and magnetic resonance imaging (MRI). DISCUSSION: The diagnostic and therapeutic problems in TBM are discussed. Moreover, the neurologic complications are presented which developed in all patients during the clinical course despite immediate antituberculous therapy.