Pathomorphosis of Tuberculosis Meningitis and the Central Nervous System in Adults (According to Sectional Material)
Authors: Sakhelashvili M.I. , Piskur Z.I. , Sakhelashvili­–Bil O.I. , Stadovych N.M. , Zolotukhin S.K. , Kolesnikova N.O. , Vasylko A.V. , Shtybel H.D. , Shevchuk Yu.B. 
Published: February 2025

Objective — to study the features of pathomorphosis of tuberculous meningitis and the central nervous system (CNS) on the basis of the analysis of sectional material for 55 years (1948—1998 and 2020—2024).
Materials and methods. 179 autopsy protocols were analyzed for patients who died in the Lviv Region from tuberculosis of the meninges and the CNS for 55 years. The studied years were divided into 6 periods: 1st — 1948—1957, 2nd — 1958—1967, 3rd — 1968—1977, 4th — 1978—1987, 5th — 1988—1998, 6th — 2020—2024.
Results and discussion. Our studies have shown that over the past 55 years there have been significant changes in the course of tuberculous meningitis and CNS due to pathomorphosis of a specific process. In particular, a significant decrease in the number of deaths from this disease from 44.1 % in the 1st period to 1.7 % in the 4th period with its subsequent increase to 5.0 % in the 5th and a sharp increase in the 6th periods to 37.5%, and combination co-infection (80.6 %). During these periods, changes in the age structure of those who died from tuberculous meningitis are noted: in the 1st period, the majority of patients (85.0 %) died at a young age (under 30 years), a gradual increase in the age of the dead and an increase in the frequency of progression of the specific process of secondary genesis are observed. The basilar form of tuberculous meningitis was most often observed (92.9 %) in the first periods. There has been a decrease in the frequency of tuberculous meningitis (up to 16.4 %) and an increase in the combination of tuberculous meningitis with meningoencephalitis (up to 83.6 %) in recent years. In this case, tuberculous meningitis is accompanied by generalized damage to the lungs and other organs and systems, especially the 6th period. Against the background of HIV-infection with tuberculous meninges and CNS was most often detected perivascular lymphoid infiltration and absence of tuberculosis granulomas. In addition, numerous vascu­litis and thrombovasculitis, fibrinous-purulent layers on the meninges were detected in the soft meninges and brain, which contributed to the emergence of zones of demyelination and softening of brain tissue during 2020—2024.
Conclusions. The tuberculosis of the meninges and CNS in most patients developed due to the progression of primary forms of a specific process, and in subsequent years — tuberculosis of secondary genesis in the first three periods. A particularly significant increase in the frequency of deaths from tuberculosis of the meninges and CNS with the progression of a specific process of secondary genesis (12.5 times). The basilar form of tuberculosis meningitis prevails (87 — 89.9 %) in the 1st and 2nd periods. How­ever, 10 (10.3 %) of those who died on autopsy were diagnosed with tuberculous meningitis and meningoencephalitis, 1 (0.9 %) — spinal meningitis, 7 (6.3 %) — solitary tuberculomas in the brain. The decrease in the incidence of the basilar form of meningitis (68.7 %) and an increase in the combination of tuberculosis of the meninges and the central nervous system (77.8 %) were observed in subsequent years. In this case, tuberculous meningitis is accompanied by generalized damage to the lungs and other organs and systems, especially the 6th period. An increase in the number of patients with HIV/AIDS infection has played a significant role in the pathomorphosis of tuberculous meningitis and meningoencephalitis in the past 5 years (2020—2024). At the same time, our studies indicate that due to the gradual improvement of chemotherapy over the years, an induced (therapeutic) pathomorphosis occurred, which significantly changed the course of a specific process in the meninges and CNS in adults.