Emergence of Tuberculous Meningitis in Egypt as an Important Public Health Problem During a Five-Year Surveillance (1998-2003)

Abstract

Tuberculous meningitis, one of the most common chronic infections of the central nervous system, had emerged as a significant cause of meningitis in Egypt. In this study we assess the epidemiology, clinical characteristics, mortality and laboratory features of tuberculous meningitis in patients during the enhanced meningitis surveillance 1998-2003. Retrospectively, we reviewed the data of 134 immunocompetent patients with culture positive Mycobacterium tuberculosis infection. The overall case fatality rate for patients with tuberculous meningitis was 47%. It was significantly higher (p< 0.001), than that for all other causes of bacterial meningitis (21.3%). The median age of cases was 23 years. They were 49.6% males and 57.5% of cases occurred in patients>20 years of age. The characteristic cerebrospinal fluid findings, included moderately elevated leucocytes count (median: 175 mm ³), decreased glucose (median: 30 mg dL ¹), elevated protein (median: 105 mg dL ¹) and proportion of lymphocytes % (median: 30). Patients had long prodromal period>5 days (65%) and low or moderate grade fever (= 38°C) was found in 70%. Tuberculous meningitis has emerged as a significant cause of bacterial meningitis in Egypt. Rapid diagnosis and earlier initiation of therapy is important to avoid the high risk of mortality or disabling neurologic sequelae.