ABSTRACT
The tuberculous meningitis stays dangerous because of its high lethality and frequent severe neurological permanent repercussions. Its prognosis is directly in relation with the precocity of its diagnosis. Well, this diagnosis is often difficult. In this work, we report a case of tuberculous meningitis in children aged 13, who is properly vaccinated. The diagnosis was made on clinical and radiological and was confirmed by late positive cultures of CSF on Lowenstein-Jensen highlighting Mycobacterium bovis BCG. TB treatment and steroids were initiated, followed by an improvement in general condition. Unfortunately, a relapse was observed after one year. The occurrence of TB meningitis in our patient leaves have two hypotheses: either an immune deviciency or ineffectiveness of the BCG vaccine. Indeed, the standard rate of immunoglobulins and the absence of recurrent infections were ruled out a deficit of humoral immunity. The study of lymphocyte markers by immunophenotyping excluded an abnormal number and distribution of T lymphocytes. An abnormality of cell proliferation was also excluded given the normal response to various antigens and mitognes. The study of the functionality of the polymorphonuclear neutrophils was normal. These normal immunological explorations showed that our patient has no immune deficiency. Several studies show that there is a genetic susceptibility to tuberculosis and it is polygenic. Hence the study of molecular genetic to research of mutations has been proposed. Others studies have highlighted the protective efficacy of BCG vaccination in children and bring into question the role of revaccination