Tuberculous meningitis in a country with a low incidence of tuberculosis: still a serious disease and a diagnostic challenge

In order to assess the present epidemiology, clinical presentation and outcome of patients with tuberculous meningitis (Tm), a retrospective study was conducted including 20 Tm patients admitted to a referral department in Denmark between January 1988 and July 2000. The findings were compared to those of a similar survey conducted 12 y earlier. A total of 65% of the patients came from countries with a high endemicity of tuberculosis, compared to only 26% in the previous survey. The overall mortality rate was 20%, with elderly patients with various pre-existing diseases being particularly affected. Neurological sequelae were seen in 50% of patients and seemed to be related to the duration of symptoms and treatment delay. The neurological state on admission and a rapid progression of symptoms seemed to be related to mortality. In 85% of the patients treatment was initiated without a definitive bacteriological diagnosis having been reached. The findings indicate that Tm is a rare but still serious disease, and one that is associated with high mortality and morbidity.