Características clínicas e laboratoriais de 62 casos de meningoencefalite tuberculosa

Nunes, Ceuci; Gomes, Irenio; Tavares, Adelci; Melo, Ailton

doi:10.1590/S0004-282X1996000200008

Resumos

Meningite tuberculosa se constitui em uma patologia endêmica há vários anos em várias cidades de países em desenvolvimento. Em Salvador foram estudados 62 pacientes com diagnóstico comprovado de meningoencefalite tuberculosa. A idade dos pacientes variou de 2 meses a 50 anos, 59,7% dos casos se encontravam na faixa etária inferior a 4 anos. O tempo de doença antes do diagnóstico variou de horas a 90 dias, com média de 13 dias. Os sinais e sintomas clínicos mais comuns foram febre (86,7%) e rigidez de nuca (81,8%). O exame de líquido cefalorraquidiano mostrou: em média celularidade de 406/mm³(4 a 1509), glicose de 37,3 mg/dL (20 a 70) e proteínas de 203 mg/dL (30 a 500); predominância de linfócitos foi observada na maioria dos casos, mas em 21,3% havia mais que 50% de polimorfonucleares.

meningoencefalite tuberculosa; meningite tuberculosa; tuberculose do sistema nervoso central; neurotuberculose; tuberculose extra-pulmonar; tuberculose

The authors present clinical, demographic and laboratory characteristics of 62 patients with proven tuberculous meningoencephalitis admitted at Couto Maia Hospital, reference for patients with infectious diseases in the State of Bahia. The patients' age varied from 2 months to 50 years, 59.7% of the cases with ages ranging from 0 to 4 years, no sex predominance. The time length for the disease varied from 0 to 90 days, average around 13 days. The most common signs and symptoms were fever and neck stiffness in 86.7 and 81.8% of the cases respectively. The cerebrospinal fluid showed cells varying from 4 to 1549/mm³, average of 406; glucose from 20 to 70 mg/dL, average of 37.3, protein from 30 to 500mg/dL, average of 203; lymphocyte predominance occurred in most cases, however in 21.3% there was predominance of neutrophils.

tuberculous meningoencephalitis; tuberculous meningitis; central nervous system tuberculosis; neurotuberculosis; extrapulmonary tuberculosis; tuberculosis

Características clínicas e laboratoriais de 62 casos de meningoencefalite tuberculosa

Clinical and laboratory characteristics of 62 tuberculous meningoencephalitis cases

Ceuci Nunes^I; Irenio Gomes^II; Adelci Tavares^I; Ailton Melo^II

^IHospital Couto Maia

^IIUniversidade Federal da Bahia (UFBA)

RESUMO

Meningite tuberculosa se constitui em uma patologia endêmica há vários anos em várias cidades de países em desenvolvimento. Em Salvador foram estudados 62 pacientes com diagnóstico comprovado de meningoencefalite tuberculosa. A idade dos pacientes variou de 2 meses a 50 anos, 59,7% dos casos se encontravam na faixa etária inferior a 4 anos. O tempo de doença antes do diagnóstico variou de horas a 90 dias, com média de 13 dias. Os sinais e sintomas clínicos mais comuns foram febre (86,7%) e rigidez de nuca (81,8%). O exame de líquido cefalorraquidiano mostrou: em média celularidade de 406/mm³(4 a 1509), glicose de 37,3 mg/dL (20 a 70) e proteínas de 203 mg/dL (30 a 500); predominância de linfócitos foi observada na maioria dos casos, mas em 21,3% havia mais que 50% de polimorfonucleares.

Palavras chave: meningoencefalite tuberculosa, meningite tuberculosa, tuberculose do sistema nervoso central, neurotuberculose, tuberculose extra-pulmonar, tuberculose.

ABSTRACT

The authors present clinical, demographic and laboratory characteristics of 62 patients with proven tuberculous meningoencephalitis admitted at Couto Maia Hospital, reference for patients with infectious diseases in the State of Bahia. The patients' age varied from 2 months to 50 years, 59.7% of the cases with ages ranging from 0 to 4 years, no sex predominance. The time length for the disease varied from 0 to 90 days, average around 13 days. The most common signs and symptoms were fever and neck stiffness in 86.7 and 81.8% of the cases respectively. The cerebrospinal fluid showed cells varying from 4 to 1549/mm³, average of 406; glucose from 20 to 70 mg/dL, average of 37.3, protein from 30 to 500mg/dL, average of 203; lymphocyte predominance occurred in most cases, however in 21.3% there was predominance of neutrophils.

Key words: tuberculous meningoencephalitis, tuberculous meningitis, central nervous system tuberculosis, neurotuberculosis, extrapulmonary tuberculosis, tuberculosis.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Aceite: 12-fevereiro-1996.

Dr. Ailton Melo - Faculdade de Medicina UFBA - Avenida Reitor Miguel Calmon s/n - 40110-100 Salvador BA - Brasil.

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2. Berman S, Kebel MA, Fouríl PB, Strebel PM. Childhood tuberculosis and tuberculous meningitis: hight incidence rates in the Western Cape of South Africa. Tubercle Lung Dis 1992;73:349-355.
³
Brasil. Ministério da Saúde. Controle da tuberculose: uma proposta de integração ensino-serviço. Ed3 rev. Rio de Janeiro: CNTC/NUTES, 1992.
4. Davis LE, Rastogi KR, Lambert CL, Skipper BJ. Tuberculous meningitis in the southwest United States: community study. Neurology 1993;43:1775-1778.
5. Frieden TR, Sterling T, Paplos-Mendez A, Kilbum JO, Cauthen GM, Dooleu S W. The emergence of drug - resistant tuberculosis in New York City. N Engl J Med,1993;328;521-526.
6. Haas DW, Prez RMD. Mycobacterium tuberculosis. In Gerald I, Mandell, E Bennett, R D (eds), Principles and practice of infectious diseases. New York: Churchill Livingstone, 1995:2213-2250.
7. HoIdinessMR. Menagement of tuberculosis meningitis. Drugs 1990;39:224-232.
8. Kaneko K, Miyatake T, Tsuji S. Rapid diagnosis of tuberculous meningitis by polymerase chain reaction (PCR). Neurology 1990;49:1617-1618.
9. Liu PYF, Shi ZY, Lau YJ, Hu BS. Rapid diagnosis of tuberculous meningitis by a simplified nested amplification protocol. Neurology 1994;44:1161-1164.
10. Machado LR, Livramento JA, Bydlowtski SP, Bravo LM, Spina-França A. Polymerase chain reaction in the diagnosis of tuberculous meningitis: preliminary report. ArqNeuropsiquiatr 1994;52:445-446.
11. Martins TS, Medeiros CO, Gerhardt GF. Meningite tuberculosa (resultados de uma pesquisa operacional). J Bras Med, 1985;48:34-41.
12. Molavi A, Lefrock JL.Tuberculous meningitis. Med Clin N Am, 1985 ;69:315-331.
13. Nardy SMC, Brólio R, Belluomini M. Aspectos epidemiológicos da meningite tuberculosa em menores de 15 anos de idade na grande São Paulo, Brasil. 1982-1983. Rev Saúde Públ 1989;23:117-127.
14. Radhakrishnan V V, Mathai A. Detection of mycobacterial antigen in cerebrospinal fluid in patients with chronic meningitis by inhibition enzyme linked immunosbent assay. Indian J Med Res, 1990;91:355-359.
15. Shankar P, Manjunath N, Mohan K, Prasad K, Behari M, Shrinivas A, Ahuja GK. Rapid diagnosis of tuberculous meningitis by polymerase chain reaction. Lancet 1991 ;337:5-7.
16. Singh NK, Singh P, Tripathi K, Sri vastava PK, Singh DS. Prognostic factors and sequelae of tuberculous meningitis in adults. J Indian MA, 1985;83:50-53.
17. Vaienzuela MT, Crrasco E, Garcia P, Toro J. Analisis retrospectivo del prognóstico de la meingitis tuberculosa en Chile en relacion al diagnostico y ai tratamiento. Enfermedades Respiratórias y Cirurgia Torácica 1988;4:124-132.
18. Vernal P, Param T, Casar C, Topeiberg S. Menigitis Tuberculosa. Rev Chil Ped, 1986;57:255-259.
19. Waecker NJ, Connor JD. Central nervous system tuberculosis in children: a review of 30 cases. Ped Inf Dis J, 1990;9:539-543.
20. Watson DG, Shnier RC, Seale JP. Central system nervous tuberculosis in Australia: report of 22 cases. Med J Austr, 1993;158:408-413.
21. Zuger A, Lowy F. Tuberculosis of the central nervous system. In Sheld WM, Whithey RJ, Durack DT (eds). Infection of the central nervous system. New York: Raven Press, 1991:425-739.

Datas de Publicação

Publicação nesta coleção
06 Dez 2010
Data do Fascículo
Jun 1996

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Azambuja HCP, Picon PD, Rizzon CFC, Coutinho M. Meningite tuberculosa. In. Picon PD, Rizzon CFC, Ott WP (eds) Tuberculose: epidemiologia diagnóstico e tratamento em clínica e saúde pública. Rio de Janeiro: MEDSI, 1993,433-452.

[2] 2. Berman S, Kebel MA, Fouríl PB, Strebel PM. Childhood tuberculosis and tuberculous meningitis: hight incidence rates in the Western Cape of South Africa. Tubercle Lung Dis 1992;73:349-355.

[3] ³
Brasil. Ministério da Saúde. Controle da tuberculose: uma proposta de integração ensino-serviço. Ed3 rev. Rio de Janeiro: CNTC/NUTES, 1992.

[4] 4. Davis LE, Rastogi KR, Lambert CL, Skipper BJ. Tuberculous meningitis in the southwest United States: community study. Neurology 1993;43:1775-1778.

[5] 5. Frieden TR, Sterling T, Paplos-Mendez A, Kilbum JO, Cauthen GM, Dooleu S W. The emergence of drug - resistant tuberculosis in New York City. N Engl J Med,1993;328;521-526.

[6] 6. Haas DW, Prez RMD. Mycobacterium tuberculosis. In Gerald I, Mandell, E Bennett, R D (eds), Principles and practice of infectious diseases. New York: Churchill Livingstone, 1995:2213-2250.

[7] 7. HoIdinessMR. Menagement of tuberculosis meningitis. Drugs 1990;39:224-232.

[8] 8. Kaneko K, Miyatake T, Tsuji S. Rapid diagnosis of tuberculous meningitis by polymerase chain reaction (PCR). Neurology 1990;49:1617-1618.

[9] 9. Liu PYF, Shi ZY, Lau YJ, Hu BS. Rapid diagnosis of tuberculous meningitis by a simplified nested amplification protocol. Neurology 1994;44:1161-1164.

[10] 10. Machado LR, Livramento JA, Bydlowtski SP, Bravo LM, Spina-França A. Polymerase chain reaction in the diagnosis of tuberculous meningitis: preliminary report. ArqNeuropsiquiatr 1994;52:445-446.

[11] 11. Martins TS, Medeiros CO, Gerhardt GF. Meningite tuberculosa (resultados de uma pesquisa operacional). J Bras Med, 1985;48:34-41.

[12] 12. Molavi A, Lefrock JL.Tuberculous meningitis. Med Clin N Am, 1985 ;69:315-331.

[13] 13. Nardy SMC, Brólio R, Belluomini M. Aspectos epidemiológicos da meningite tuberculosa em menores de 15 anos de idade na grande São Paulo, Brasil. 1982-1983. Rev Saúde Públ 1989;23:117-127.

[14] 14. Radhakrishnan V V, Mathai A. Detection of mycobacterial antigen in cerebrospinal fluid in patients with chronic meningitis by inhibition enzyme linked immunosbent assay. Indian J Med Res, 1990;91:355-359.

[15] 15. Shankar P, Manjunath N, Mohan K, Prasad K, Behari M, Shrinivas A, Ahuja GK. Rapid diagnosis of tuberculous meningitis by polymerase chain reaction. Lancet 1991 ;337:5-7.

[16] 16. Singh NK, Singh P, Tripathi K, Sri vastava PK, Singh DS. Prognostic factors and sequelae of tuberculous meningitis in adults. J Indian MA, 1985;83:50-53.

[17] 17. Vaienzuela MT, Crrasco E, Garcia P, Toro J. Analisis retrospectivo del prognóstico de la meingitis tuberculosa en Chile en relacion al diagnostico y ai tratamiento. Enfermedades Respiratórias y Cirurgia Torácica 1988;4:124-132.

[18] 18. Vernal P, Param T, Casar C, Topeiberg S. Menigitis Tuberculosa. Rev Chil Ped, 1986;57:255-259.

[19] 19. Waecker NJ, Connor JD. Central nervous system tuberculosis in children: a review of 30 cases. Ped Inf Dis J, 1990;9:539-543.

[20] 20. Watson DG, Shnier RC, Seale JP. Central system nervous tuberculosis in Australia: report of 22 cases. Med J Austr, 1993;158:408-413.

[21] 21. Zuger A, Lowy F. Tuberculosis of the central nervous system. In Sheld WM, Whithey RJ, Durack DT (eds). Infection of the central nervous system. New York: Raven Press, 1991:425-739.