NEW MICROBIOLOGICA, 36, 193-198, 2013 Stroke in patients with tuberculous meningitis in a low TB endemic country: an increasing medical emergency? Maria Bruna Pasticci 1 , Maurizio Paciaroni 2 , Piero Floridi 3 , Lisa Malincarne 1 , Matteo Scavizzi 1 , Franco Baldelli 1 1 Infectious Disease Section, Department of Experimental Medicine and Biochemical Sciences, University of Perugia, Perugia, Italy; 2 Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy; 3 Department of Neuroradiology, Santa Maria della Misericordia Hospital, Perugia, Italy Meningitis is the most frequent manifestation of central nervous system (CNS) disease due to Mycobacterium tuberculosis, making up 1-10% of all TB cases (Rock et al., 2008; Kalita et al., 2009; Garg, 2010). However, the global incidence and prevalence of tuberculous meningitis (TBM) is not precisely known (Garg, 2010). Being a child, HIV co-infected or having other immunocom- promised diseases are recognised risk factors for TBM. Additionally, non-native persons residing in developed countries also tend to be at higher Corresponding author Prof. Maria Bruna Pasticci Infectious Disease Section Department of Experimental Medicine and Biochemical Sciences University of Perugia Viale Zefferino Faina, 0 - 06100 Perugia, Italy E-mail pasticci@unipg.it risk of TBM (Rock et al., 2008; Kruijshaar et al., 2009; Peto et al. 2009; Garg, 2010; Garg et al. 2011; Christensen et al., 2011; Marais et al., 2011). In a five year retrospective study carried out in Spain between 1985 and 1990, HIV antibodies were de- tected in 10% of culture proven TBM but only 2% of HIV-negative individuals were diagnosed with culture proven TBM (Berenguer et al., 1992). A large Indian study reported TBM in 25 (7%) out of 163 HIV co-infected patients admitted with TB between 2001 and 2003 (Attili et al., 2005). The re- ported rate of HIV-associated TBM was also 7% among 43 patients with TBM in a Thailand study (Helbok et al. 2006). From a prospective Indonesian adult meningitis cohort study, in- cluding 183 patients with meningitis, M. tuber- culosis resulted the most frequent aetiology, a to- tal of 153 cases, with 31 being HIV-infected (Ganiem et al., 2009). Stroke due to brain vascular disease is a serious complication of tuberculous meningitis (TBM). This study evaluat- ed the frequency, clinical characteristics, risk factors and outcomes of patients with TBM complicated by stroke ad- mitted to the Infectious Disease Clinic, University of Perugia Hospital, Italy from 1971 to 2010. Over four decades, 419 patients were admitted with tuberculosis, of these 30 (7.1%) were diagnosed with TBM: 20 def- inite, one probable and nine possible. Twenty-six were evaluable for stroke and six (23%) had stroke. The latter six had advanced stages of meningitis, two tested HIV positive, three HIV negative and in one HIV was not performed. Of sev- en patients without stroke tested for HIV, only one resulted positive. No differences were found regarding CSF cell count, sugar, protein, microscopy or growth of Mycobacterium tuberculosis among patients with or without stroke. The over- all survival rate at discharge was 83% in patients with stroke and 95% in those without stroke. It was found that stroke can be frequent among patients with TBM and the presence of HIV infection might be associated with a higher rate of stroke. Further research is needed on these findings, especially in low TB endemic countries. KEY WORDS: Stroke, Tuberculous meningitis, HIV co-infection. SUMMARY Received November 19, 2012 Accepted January 14, 2013