Diagnóstico de meningitis tuberculosa

Tuberculosis is still a public health problem worldwide and it's meningeal form is a critical clinical condition, contributing great part of tuberculosis related deaths and disabilities. Although early treatment improves disease prognosis, managing a precocious diagnosis is a key problem because clinical symptoms are not specific. Even though some cerebrospinal fluid findings may be useful, Ziehl-Neelsen smear staining is seldom positive and culture results take a long time. While Mycobacterium tuberculosis nucleic acid detection has been tested producing very variable results, indirect methods such as ADA (adenosine deaminase) and ELISPOT and tuberculin skin testing (TST) may be helpful in some cases. Given there is no single, rapid test with good sensitivity and specificity for meningeal tuberculosis diagnosis, the main clinical prediction rules integrating clinical and laboratory aspects, are described. To improve accuracy, CT scan o MRI results are also added to the diagnostic workup process. Since meningeal TB diagnosis can only be achieved taking into account epidemiological, laboratory blood and cerebrospinal fluid testing as well as imaging, the utility of existing clinical prediction rules needs to be assessed in settings different from those where they were initially developed.