Resumen de Meningitis tuberkulosoa, ezohikoa baina posiblea

Aitor San Martin Sagarzazu, Elisa Garrote Llanos, J. Rementería Radigales, Nerea Rodriguez Cano, Patricia Peña Torre, Henar Uriarte Gutierrez, Victor Vidal Alba

• English

  Tuberculosis is an underdiagnosed infection. Young children are at greater risk of suffering from severe extrapulmonary forms. In 4% of children with Mycobacterium tuberculosis infection, the disease extends to the central nervous system. Among the conditions that induce the greatest morbidity and mortality is tuberculous meningitis.

  As a result of this, we will analyze three cases of tuberculous meningitis with follow-up in Basurto Hospital to raise awareness about this entity. The first one was a 14-year-old girl who was admitted for disturbance, confusion and dysphasia and Mycobacterium tuberculosis DNA was detected in the cerebrospinal fluid with good clinical evolution after treatment. The other two cases consulted for long-term fever, a 12-month-old boy with cough and rhinorrhea and an 18-month-old girl with vomiting. Both developed hydrocephalus and required placement of a ventriculoperitoneal valve. In all cases microbiological tests were positive. All three presented hypoglycorrhachia, elevated protein levels and pleocytosis. In all of them the index case was a relative.

  In the case of tuberculous meningitis, early diagnosis is key for prognosis. However, there are difficulties in performing it, especially because at first the symptoms are nonspecific and the microbiological tests have low profitability. For this reason, it is important to include it in the differential diagnosis and ask about family members who could have tuberculosi.

• euskara

  Tuberkulosia azpidiagnostikatutako infekzioa da. Ume txikiek birikaz kanpoko tuberkulosiaren forma larriak izateko arrisku handiagoa dute. Mycobacterium tuberculosis bakterioak sortutako infekzioa duten umeen %4 artean, nerbio-sistema zentralera zabaltzen da. Morbimortalitate handiena sortzen duen gaitzen artean meningitis tuberkulosoa azaltzen da.

  Honen harira, Basurtuko ospitalean meningitis tuberkulosoa izan duten 3 pazienteren kasuak aztertuko ditugu gaitz hau aditzera emateko. Lehenengoa, 14 urteko neska bat, aztoramen, nahaste eta disfasiagatik kontsulta egin eta tratamenduarekin bilakaera ona izan zuena. Beste biek epe luzeko sukarrarengatik kontsultatu zuten, 12 hilabeteko mutilak eztula eta mukiekin eta 18 hilabeteko neskak gorakoekin; biek hidrozefalia garatu zuten deribazio bentrikuluperitonealaren beharrarekin. Hirurek proba mikrobiologiko positiboak izan zituzten eta likido zefalorrakideoan glukosa baxua, proteina igoera eta pleozitosia izan zituzten. Kasu guztietan familiako kideren bat izan zen indize-kasua.

  Meningitis tuberkulosoaren kasuan, diagnostiko goiztiarrak pronostikoan eragin handia du. Dena den, diagnostikoa ez da erraza izaten, batik bat hasieran sintomak inespezifikoak eta aldakorrak direlako eta proba mikrobiologikoen errentagarritasuna baxua delako. Horregatik, garrantzitsua da aukera diagnostiko gisa kontuan izatea eta tuberkulosia izan dezaketen familiako kideengantik galdetzea.