Title : Outcomes of severe tuberculous meningoencephalitis in ICU: Risk factors and clinical evolution
Abstract:
Introduction:Tuberculosis is a serious public health problem in our Moroccan context, with the neuro-meningeal localization being the most severe form, responsible for death and severe neurological sequelae despite anti-bacillary treatment. The prognosis is closely related to the early diagnosis and the quality of care provided. The aim of our study was to analyze the epidemiological, clinical, therapeutic, and evolutionary aspects of severe tuberculous meningoencephalitis in the intensive care unit, as well as the prognostic factors associated with mortality.
Patients and Methods:This is a retrospective, descriptive, and analytical study conducted over a period of 8 years, where we collected 20 cases of severe tuberculous meningoencephalitis from patients admitted to the medical intensive care unit of Ibn Rochd University Hospital in Casablanca.
Results:The average age in our series was 40.2 years, with a slight female predominance. A history of tuberculous exposure was found in 15% of patients, and 30% had a history of tuberculosis. The average consultation delay was 17.44 days. Clinical signs were of subacute onset in 80% of cases. The initial symptoms were dominated by general signs. The deterioration was marked by the onset of consciousness disturbances with headaches in all patients, associated with vomiting, convulsions, cranial nerve palsies, sensory-motor deficits, basal signs, and psychiatric manifestations. According to the BRC classification, 70% of the cases were classified as grade III. Bacteriological confirmation was achieved through PCR and the GeneXpert test. Brain imaging revealed tuberculomas in 25% of patients, leptomeningitis in 20%, hydrocephalus in 20%, and cerebral infarction in 5%. Pulmonary imaging showed abnormalities suggestive of tuberculosis in five patients. The search for bacilli in extra-cerebral locations was positive in two cases (pulmonary and lymphatic). All patients received anti-tuberculosis treatment combined with corticosteroids and anticonvulsants. The outcome was fatal in 70%, and marked by persistent neurological sequelae in 5%. The risk factors for mortality included immunodeficiency, poor general condition, low GCS score, proteinorachia, high leukocytosis, elevated APACHE II and SOFA scores, and grade III in the BMRC classification.
Conclusion:Our results are generally consistent with the literature on tuberculous meningoencephalitis. The study highlights the importance of early diagnosis and appropriate management, which are major determinants of prognosis, and which remain conditioned by the stage of the disease at the time of admission.
