Treatment
Two patients did not receive antituberculous treatment. An
HIV-infected patient who presented with lymphocytic meningitis
and for whom a CSF culture was positive for Nocardia
asteroides died; autopsy and postmortem growth from CSF
samples revealed disseminated tuberculosis with meningeal
involvement. Another institutionalized psychiatric patient who
presented with an unexplained increase in the rate of seizure
episodes was admitted to the hospital because of severe
multiorgan failure and died in 24 hours; autopsy demonstrated
disseminated tuberculosis with meningitis.
The remaining 46 patients received therapy with a combination
ofisoniazid and rifampin and ethambutol and streptomycin
(5), ethambutol and pyrazinamide (29), ethambutol alone (10),
and amikacin alone (2). Fifteen patients were treated concomitantly
for a cerebral pyogenic abscess or listeriosis until confirmation
of tuberculous meningitis. During hospitalization in
the ICU, adverse effects (cytolytic hepatitis) leading to definitive
interruption of treatment with isoniazid (three cases) and
pyrazinamide (five cases) were observed. Treatment with both
drugs had to be definitively interrupted in one patient. Steroid
treatment was given to 31 patients. The reasons for not giving
steroids therapy to the remaining patients were stage 1 illness
(4 cases) and uncertain diagnosis of tuberculosis and