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Boletín Médico del Hospital Infantil de México

2006, Número 5

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Bol Med Hosp Infant Mex 2006; 63 (5)


Infección por micobacterias del sistema nervioso central

Morales-Aguirre JJ

Idioma: Español
Referencias bibliográficas: 160
Paginas: 332-350
Archivo PDF: 122.01 Kb.


RESUMEN

La meningitis tuberculosa es la infección más grave causada por Mycobacterium tuberculosis, representa 5 a 15% de las formas de tuberculosis extrapulmonar. Las manifestaciones clínicas se dividen en 3 estadios, siendo los principales signos y síntomas descritos: fiebre, vómito, apatía, anorexia, irritabilidad, infección de vías respiratorias altas, cefalea, dolor abdominal, convulsiones, constipación, letargo, rigidez de nuca, tos, pérdida de peso e hidrocefalia. El diagnóstico de tuberculosis meníngea es difícil ya que la radiografía de tórax, PPD y cultivo de micobacterias son habitualmente negativos, debido a la baja cantidad de micobacterias en el líquido cefalorraquídeo, por lo que el diagnóstico constituye un reto para el clínico. El tratamiento recomendado actualmente sugiere usar 2 meses isoniacida, rifampicina, estreptomicina y pirazinamida, seguido de isoniacida y rifampicina por 7-10 meses, además del uso de corticosteroides. Las secuelas graves son más frecuentes en estadios avanzados de la enfermedad. Antes de que la quimioterapia se introdujera, los casos de tuberculosis fallecían en un período de 3 a 4 semanas. Actualmente, el tratamiento apropiado durante la primera fase permite una supervivencia de prácticamente 100% de los pacientes, aunque es posible que quede algún daño cerebral.


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