RESUMO
Background: The British Medical Research Council (BMRC) staging has been extensively used to evaluate the disease severity and establish the approximate prognosis of tuberculous meningitis. Aims: This study aimed at analyzing the predictive accuracy for mortality and neurological sequelae of a set of clinical features, laboratory tests and imaging. Methods: We compared the British Medical Research Council (BMRC) staging with a new scoring proposal to predict the prognosis of patients with Central Nervous System Tuberculosis. Data from Ecuador was collected. A score was built using a Spiegelhalter and Knill-Jones method and compared with BMRC staging with a ROC curve. Results: A total of 213/310 patients (68.7%) were in BMRC stage II or III. Fifty-seven patients died (18.3%) and 101 (32.5%) survived with sequelae. The associated predictors were consciousness impairment (p= 0.010), motor deficit (p = 0.003), cisternal effacement (p=0.006) and infarcts (p=0.015). The new score based on these predictors yielded a larger area under the curve of 0.76 (95% CI: 0.70-0.82), but not significantly different from the BMRC (0.72: 95% CI: 0.65-0.77). Conclusions: This modern score is easy to apply and could be a sound predictor of poor prognosis. However, the availability of modern tests did not improve the ability to predict a bad outcome.
Assuntos
Adulto , Diagnóstico por Imagem/métodos , Progressão da Doença , Equador/epidemiologia , Feminino , Humanos , Incidência , Masculino , Mycobacterium tuberculosis/isolamento & purificação , Prognóstico , Curva ROC , Estudos Retrospectivos , Índice de Gravidade de Doença , Taxa de Sobrevida/tendências , Tuberculose Meníngea/diagnóstico , Tuberculose Meníngea/epidemiologia , Tuberculose Meníngea/epidemiologia , Tuberculose Meníngea/microbiologiaRESUMO
Background: The British Medical Research Council (BMRC) staging has been extensively used to evaluate the disease severity and establish the approximate prognosis of tuberculous meningitis. Aims: This study aimed at analyzing the predictive accuracy for mortality and neurological sequelae of a set of clinical features, laboratory tests and imaging. Methods: We compared the British Medical Research Council (BMRC) staging with a new scoring proposal to predict the prognosis of patients with Central Nervous System Tuberculosis. Data from Ecuador was collected. A score was built using a Spiegelhalter and Knill-Jones method and compared with BMRC staging with a ROC curve. Results: A total of 213/310 patients (68.7%) were in BMRC stage II or III. Fifty-seven patients died (18.3%) and 101 (32.5%) survived with sequelae. The associated predictors were consciousness impairment (p= 0.010), motor deficit (p = 0.003), cisternal effacement (p=0.006) and infarcts (p=0.015). The new score based on these predictors yielded a larger area under the curve of 0.76 (95% CI: 0.70-0.82), but not significantly different from the BMRC (0.72: 95% CI: 0.65-0.77). Conclusions: This modern score is easy to apply and could be a sound predictor of poor prognosis. However, the availability of modern tests did not improve the ability to predict a bad outcome.
Assuntos
Adulto , Diagnóstico por Imagem/métodos , Progressão da Doença , Equador/epidemiologia , Feminino , Humanos , Incidência , Masculino , Mycobacterium tuberculosis/isolamento & purificação , Prognóstico , Curva ROC , Estudos Retrospectivos , Índice de Gravidade de Doença , Taxa de Sobrevida/tendências , Tuberculose Meníngea/diagnóstico , Tuberculose Meníngea/epidemiologia , Tuberculose Meníngea/microbiologiaRESUMO
A tuberculose permanece como uma das doenças infecciosas mais freqüentes no mundo. No presente estudo, relatamos um caso de meningite tuberculosa, que evoluiu com bloqueio do fluxo do líquido cefalorraqueano (LCR), causando dificuldade diagnóstica. Discute-se a importância da localização da lesão e sua influência no exame do LCR como apoio ao diagnóstico da meningite tuberculosa. No caso relatado, a pesquisa do bacilo álcool-ácido resistente foi positiva no LCR cisternal e negativa no LCR lombar e ventricular, demonstrando que a maior acurácia do teste esteve relacionada a maior proximidade da lesão inflamatória.
Assuntos
Adulto , Humanos , Masculino , Tuberculose Meníngea/líquido cefalorraquidiano , Líquido Cefalorraquidiano/fisiologia , Técnicas de Diagnóstico Neurológico , Evolução Fatal , Região Lombossacral , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose Meníngea/diagnóstico , Tuberculose Meníngea/microbiologiaRESUMO
Se determinó la magnitud de la resistencia del Mycobacterium tuberculosis a las drogas antibacilares en pacientes con meningitis tuberculosa con y sin antecedentes de tratamiento. Se estableció una resistencia de 20,0 y 9,9 por ciento respectivamente. Estas cifras coinciden en las encontradas en las otras localizaciones de tuberculosis por lo que no debe esperarse un mayor porcentaje de fracasos terapéuticos por esta causa. A pesar de ello, dada la gravedad de la localización meníngea continuaremos determinando el patrón de resistencia en todo nuevo caso de meningitis tuberculosa