Tuberculous meningitis: difficulties in diagnosis and treatment

Abstract

In studying patients with clinical course, diagnosis and treatment of meningitis in conditions of high HIV prevalence, in 20 patients treated in 5 TB unit and 1 branch "Kristall" of Beloyarsky, Sverdlovsk region, in 2018, it was established that patients with HIV infection accounted for 95%, 95% died, generalized tuberculosis was detected in 83% of patients, the immediate cause of death was the progression of tuberculous meningitis in 22% of patients, the severity of the underlying disease, HIV infection in 28 %, progression of mixed infection - in 6%, cryptococcal infection - in 6%. Laboratory characteristics of cerebrospinal fluid do not give 100% information about the etiologic agent. Difficulties in treatment are determined by the lack of antiretroviral therapy, the difficulty of detecting the etiologic agent, the high prevalence of multiple and broadest resistance of mycobacterium tuberculosis (91%) to antituberculosis drugs.