SUMMARYIn developing countries tuberculous meningitis is a difficult infection to differentiate from other central nervous system (CNS) infections. This paper presents the history, physical findings, laboratory data, and clinical course of 100 patients who were admitted to a special ward and had CSF cultures positive for Mycobacterium tuberculosis. Fifty-four patients were comatose when admitted and 76 had meningeal signs. Mean admission CSF values were WBC 531, glucose 23 mg/dl, and protein 166 mg/dl. Only two CSF AFB smears were positive. Sixty-one percent of the chest X-rays taken were consistent with pulmonary tuberculous and 390 were normal. Twenty-four patients died within the first week after admission, before the clinical diagnosis was made and anti-tuberculous therapy could be started. Fifty-three of 76 patients given antituberculous therapy died. Neurologic sequelae developed in 48 % of the survivors. The high mortality and morbidity rates in this patient-group were due to the severity of illness on admission and the predominance of children (54 %).

Twenty-seven patients with tuberculous meningitis (TBM) were treated with ethambutol, isonicotinic acid hydrazide, streptomycin and dexamethasone and 28 were treated with triple anti-tuberculous drugs only. Only two of the patients to whom steroids were given developed ocular complications as compared to seven of those not receiving dexamethasone. High dose dexamethasone apparently prevents optic atrophy in TBM. Controlled double-blind studies with and without dexamethasone are needed to confirm this postulation.

Hearing affection as a sequel of meningococcal meningitis and its relation to age, sex, severity and duration of disease was studied in Cairo, Egypt during the period December 1966--December 1973. The total incidence of impaired hearing in the 775 cases was 5.8%. This incidence was higher in the younger age groups, females, severe cases of meningitis and in patients who received specific therapy shortly after the onset of signs and symptoms of the disease. The aetiology of hearing impairment in meningitis was reviewed.

The penetration of amoxicillin into cerebrospinal fluid (CFS) in the presence of meningeal inflammation was evaluated in patients with tuberculous meningitis. Serum and CSF concentrations of amoxicillin were measured at 2 h in nine patients who received a 1-g oral dose and at 1.5 and 4 h in ten patients who received a 2-g intravenous injection of sodium amoxicillin. After the oral dose, CSF concentrations ranged from 0.1 to 1.5 μg/ml. After the intravenous injection, CSF concentrations ranged from 2.9 to 40.0 μg/ml at 1.5 h and from 2.6 to 27.0 μg/ml at 4 h. These data on penetration suggest that parenterally administered sodium amoxicillin may be of value in the therapy of acute bacterial meningitis.

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