Study of Central Nervous System Tuberculosis over a Decade, 2003-2012. Immigration and Drug Resistance

Introduction: Central nervous system tuberculosis (CNS-TB) is uncommon but is among the most severe presentations of tuberculosis. We studied CNS-TB over 10 consecutive years (2003-2012) at Basurto University Hospital (Spain).Methods: This was a retrospective descriptive study of all patients diagnosed with CNS-TB between 1 January 2003 and 31 December 2012. We analysed epidemiological, clinical and microbiological characteristics of the disease, the association between TB and HIV, treatments including adverse effects and resistance, mortality, sequelae and migrant status. The study was approved by the hospital’s Ethics and Research Unit.Results: Out of 526 patients with TB, 23 (4.3%) were diagnosed with CNS-TB. Of these, 39% were foreign born, none were <20 years of age, and half were HIV positive. The mortality rate was 22%-30%. The most common symptoms were fever (60%) and altered consciousness (60%); 39% of patients had TB at another site, 78% had tuberculous meningitis and 95% had elevated cerebrospinal fluid adenosine deaminase levels. Overall, 83% received quadruple therapy Two foreign-born individuals relapsed.  No drug resistance was observed.Conclusions: Overall, CNS-TB accounts for 4.3% of TB cases, tuberculous meningitis being the most common form. No cases were observed in children. Patients with TB including CNSTB should undergo HIV serological screening.A disproportionate number of cases of CNS-TB occur in immigrants and hence they should be a target population for improving TB control in our setting. It is important to identify patients’ place of origin, to ascertain the prevalence of TB and level of drug resistance there, as this information might influence their management.