Neuromeningeal tuberculosis in HIV-negative patients: a retrospective study in Rabat, Morocco

Abstract

Neuro-Meningeal Tuberculosis (NMT) is a severe infection of the central nervous system which causes a public health problem in Morocco and in several countries in the world. In order to describe the epidemiological, clinical, paraclinical and outcome among NMT patients without HIV, we carried out a retrospective study at the neurology department of the Military Hospital of Rabat in Morocco, over a period of 17 years (2000-2017). Forty patients were included with a mean age of 44 years (± 18) and a sex ratio of 1.66. A history evoking the possibility of tuberculous origin was found in 8 patients (20%). Febrile confusion was the most common clinical manifestation and was observed in 22 patients (55%) followed by febrile meningeal syndrome in 12 patients (30%). The main abnormalities noted in brain magnetic resonance imaging (MRI) were: hydrocephalus in 13 cases (32.5%), intra-cranial tuberculomas in 10 patients (25%) and leptomeningitis in 9 cases (22.5%). Cerebrospinal fluid study found clear aspect in 29 patients (75%), direct acid fast bacilli smear examination was positive in 4 patients (10%) and positive culture in 4 patients (10%). The Polymerase chain reaction (PCR) study returned positive in 6 patients (35%) of the 17 patients tested. The outcome was good in 18 patients (45%) while 19 patients suffered from neurological sequelae (47.5%) and 3 cases of death recorded (7.5%). Febrile confusion was the most reported manifestation in our patients. Subacute onset of symptoms was the most predominant feature in our patients as reported in the literature. Our results are consistent with the literature and confirm the severity of this infectious disease, even in HIV-negative patients.

Prevalence, treatment outcomes and determinants of TB/HIV coinfection: A 4-year retrospective review of national tuberculosis registry in a country in a MENA region

“…HIV can increase the risk of developing active TB up to 30 times [ 11 ], lead to atypical clinical manifestations of TB, complicate diagnosis and treatment, and ultimately affect the prognosis of TB disease [ 8 ]. In contrast, TB slows down the recovery of CD4 + T lymphocytes [ 12 ], increases viral replication [ 13 ], and accelerates the progression of AIDS and death in HIV patients by 6–8 times [ 7 ]. The World Health Organization's latest report shows that approximately 10.6 million people were diagnosed with TB in 2021, resulting in 1.6 million deaths due to the disease, including 187,000 TB-related deaths among those with HIV [ 14 ].…”