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

BACKGROUND
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.


METHODS
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.


RESULTS
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.


CONCLUSION
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.