The Great Simulator: Meningeal Tuberculosis: Clinical Case

Abstract

Tuberculosis (TB) is the most important infectious- contagious disease in the world, associated with high morbidity and mortality, mainly pulmonary, but it can affect other organs and tissues. In the pediatric age it has been an occult epidemic because of its low infective capacity and lower incidence compared to adults. The World Health Organization (WHO) 2015 estimated one million children with TB in the world and 169,000 deaths. According to the WHO, Honduras ranks eighth in the burden of tuberculosis in the Western Hemisphere. These data reflect that it remains a priority public health problem. In countries of high endemicity, the main sweep is poverty and poor access to the health system. The incidence of meningeal tuberculosis (MTB) is directly related to the prevalence of pulmonary TB (TB) and although it represents only about 1% of cases of TB and 5%-10% of extrapulmonary TB, its presence is worrying because of its high Mortality rate (30%) in those patients receiving optimal treatment and half of the survivors are left with severe sequelae, so the most important factor influencing the prognosis is early diagnosis and early initiation of specific treatment. The diagnosis of TBM often presents a challenge for the physician; A high degree of clinical suspicion is needed to avoid delaying diagnosis and treatment since the clinical picture is non-specific, heterogeneous and although cerebrospinal fluid (CSF) examination provides sugges- tive data, empirical treatment is usually initiated without being sure that the diagnosis Will be confirmed. The clinical manifestations and their duration are of vital importance for their suspicion.