Tuberculous meningitis:: A report of a rare case in the Czech Republic in 2003

A case-report of a 38-year-old female who succumbed to tuberculous meningitis is presented. At the beginning, the disease manifested as aseptic meningitis. However, the first analysis of cerebrospinal fluid (CSF) revealed a reduced CSF/blood glucose ratio, and the concentration of chlorides was at the lower range of normal values. In the course of the disease the cytology of CSF showed a shift to neutrophils, levels of glucose and chlorides continued to decrease. A specialized CSF examination demonstrated increased percentage of NK cells and CD8+ T lymphocytes, CSF levels of IL-6, IL-8 and cortisol were elevated as well. Mycobacterium tuberculosis was detected in CSF both with culture and RNA amplification and detection of the PCR product with chemiluminiescence. Intrathecal antituberculous antibodies were negative. The authors have discussed diagnostic approach to tuberculous meningitis in a region with a low prevalence of tuberculosis.