The importance of a correct and prompt diagnostic in a case of bacillar meningo-encephalitis
Authors:   Doctoral School, “Carol Davila” University of Medicine and Pharmacy Bucharest, “Matei Bals” National Institute of Infectious Diseases, Bucharest, Romania, Chitu Marius Costin , Raducanu Paula-Roxana ,   Department of Intensive Care Unit, Emergency Clinical Hospital, Bucharest, Romania, Dima Vlad ,   Department of Obstetrics, Gynecology and Neonatology, Filantropia Clinical Hospital, Bucharest, Romania, Mihai Bianca-Margareta ,   Department of Obstetrics, Gynecology and Neonatology, Filantropia Clinical Hospital, Bucharest, Romania, Salmen Teodor ,   Doctoral School, “Carol Davila” University of Medicine and Pharmacy Bucharest, “N. C. Paulescu” National Institute for Diabetes Mellitus, Nutrition and Metabolic Disorders, Bucharest, Romania, Andrei Olivia ,   National Institute of Neurology and Neurovascular Disorders, Bucharest, Romania, Potcovaru Claudia Gabriela ,   Doctoral School, “Carol Davila” University of Medicine and Pharmacy Bucharest, National Institute of Rehabilitation, Physical Medicine and Balneoclimatology, Bucharest, Romania, Mischianu Dan Liviu-Dorel ,   Department of Urology “Carol Davila” University of Medicine and Pharmacy Bucharest, “Carol Davila” Emergency University Central Military Hospital, Bucharest, Romania,   The Association of Scientists from Romania, Bucharest, Romania, Bohiltea Roxana Elena ,   Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy Bucharest, Filantropia Clinical Hospital, Bucharest, Romania
Published: December 2022

Introduction. Meningitis is the inflammation of the meninges and can be of infectious cause, the most common being viral, followed by bacterial, but which associates a more severe and rapid evolution, even when it is treated correctly and promptly. In infants and children tuberculous meningitis develops more frequently as a complication of progressive primary infection. Case presentation. A 12-year-old female patient presents to the emergency room with fronto-parietal headache, vomiting, vertigo and lumbar pain, which, despite treatment with oral cephalosporin, returns after 3 days, because the symptoms persist. She is admitted, her treatment is escalated, IV fluoroquinolones and acyclovir are added, along with corticotherapy and cerebral depletives, but within 48 hours the general condition worsens, associating severe headaches, neck stiffness and personality disturbances. Lumbar puncture detects high levels of leukocytes and proteins and low levels of glucose and chlorine, so the patient is transferred to an Intensive Care Unit, intubated and mechanically ventilated. MRI reveals meningoencephalitis with ponto-mesencephalic and cerebellar involvement, with biological minimal leukocytosis with neutrophilia and minimal inflammatory syndrome, the repeated lumbar puncture present the same pathological elements, but the PCR of CSF is positive for Mycobacterium tuberculosis and the diagnosis is of severe tuberculous meningoencephalitis. Under tuberculostatic treatment (isoniazid 5 mg/kg/day, rifampicin 10 mg/kg/day, ethambutol 20 mg/kg/day, pyrazinamide 30 mg/kg/day) associated with vitamin therapy (B1 and B6 – to prevent peripheral neuropathy induced by isoniazid), corticotherapy and cerebral depletives, after 5 days, the evolution was towards healing, which allowed extubation and later discharge, continuing the 7/7 tuberculostatic scheme for 30 days. A subsequent pulmonary assessment is necessary for conversion to 2/7 regime. Conclusions. Meningitis must be promptly and correctly diagnosed and treated, otherwise the evolution is serious, the patient may develop sequelae or even develop towards death. An important element is the anamnesis, because in the presents case, a member of the patient’s family has recently been hospitalized for a respiratory pathology for which he required oxygen therapy.