Journal
JAPANESE JOURNAL OF INFECTIOUS DISEASES
Volume 67, Issue 1, Pages 50-53Publisher
NATL INST INFECTIOUS DISEASES
DOI: 10.7883/yoken.67.50
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Central nervous system tuberculosis (CNS-TB) is a devastating manifestation of tuberculosis (TB) caused by the hematogenous spread of Mycobacterium tuberculosis. Here, I present a retrospective analysis of 20 CNS-TB cases in Israel, a country with a low incidence of TB over an 11-year period (2000-2010). Most of the cases were those of African migrants, with an increased prevalence in adult females and in those with HIV coinfections. Clinical manifestations were usually non-specific, and miliary infiltrates were rare. Lymphocytic meningitis was frequent with bacteriological confirmation in 50% of the cases. The yields of cerebrospinal fluid smear examinations were low (20%). Brain computed tomography revealed tuberculomas (45%) and hydrocephalus (15%). All patients received individual treatment on the basis of drug susceptibility patterns and adjunctive steroid therapy. However, 35% of the patients died within the first year and the mortality rate was strongly correlated to disease severity (90%), HIV coinfection (85%), and hydrocephalus (66%). Progress in new diagnostic tests and early treatment may improve the current high mortality and morbidity rates.
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