British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children

Thwaites, Guy; Fisher, Martin; Hemingway, Cheryl; Scott, G.M.; Solomon, Tom; Innes, John

doi:10.1016/j.jinf.2009.06.011

Cited by 493 publications

(511 citation statements)

References 167 publications

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“…Guidelines generally recommend treatment with rifampicin, isoniazid, pyrazinamide and streptomycin (or ethambutol) for 3 months in the intensive phase, followed by at least a 6-month period of treatment with rifampicin and isoniazid [1,73,74].…”

Section: Specific Antituberculous Treatmentmentioning

confidence: 99%

Tuberculous Meningitis in Adults: A Review of a Decade of Developments Focusing on Prognostic Factors for Outcome

2012

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Tuberculous meningitis (TBM) is the most severe form of TB. Despite treatment, mortality and long-term disability remain unacceptably high. Prevention, early recognition, diagnosis and treatment are fundamental to improving outcomes. However, an effective vaccine remains elusive, initial symptoms are nonspecific, and sensitive diagnostic tests are not available. There has been progress in our understanding of the immunopathology of TBM, and several factors have been found to be associated with susceptibility to infection, disease progression and clinical outcome. However, these have not yet impacted on treatment. Early treatment initiation and uninterrupted continuation, severity on presentation, seizures, stroke, cranial nerve involvement, cerebrospinal fluid cell count and lactate levels, hyponatreamia and coinfection with HIV are all found to be important prognostic factors for outcome. Pathogen lineage (Beijing genotype) and host genetics (polymorphisms in TLR2, TIRAP and LTA4H genes) can influence susceptibility to TBM. However, these findings have not yet impacted on treatment. Progress in vaccine development, opportunities for better diagnostic tests, novel insights into pathogenesis and an increasing evidence base for improving treatment should impact the current high mortality and morbidity, if translated to global and local guidelines.

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Section: Specific Antituberculous Treatmentmentioning

confidence: 99%

Tuberculous Meningitis in Adults: A Review of a Decade of Developments Focusing on Prognostic Factors for Outcome

2012

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“…On the other hand, streptomycin does not penetrate the CSF well in the absence of inflammation. In addition, fluoroquinolones may represent an effective fourth agent, although data concerning their CSF pharmacokinetics and safety during prolonged therapy are limited 13 .…”

Section: Discussionmentioning

confidence: 99%

Ring enhancing intracranial lesion responding to antituberculous treatment in an HIV-infected patient

Pellegrino

Gerhardt

Porfirio

et al. 2010

Rev. Inst. Med. trop. S. Paulo

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Cerebral tuberculomas constitute a major differential diagnosis of cerebral toxoplasmosis in human immunodeficiency virus (HIV)-infected patients in developing countries. We report the case of a 34-year old woman co-infected with HIV and possible disseminated tuberculosis (hepatitis, lymphadenopathy, and pleural effusion) who presented a large and solitary intracranial mass lesion. Despite extensive diagnostic efforts, including brain, ganglionar, and liver biopsies, no definitive diagnosis was reached. However, a trial with first-line antituberculous drugs led to a significant clinical and radiological improvement. Atypical presentations of cerebral tuberculomas should always be considered in the differential diagnosis of intracranial mass lesions in HIV-infected patients and a trial with antituberculous drugs is a valuable strategy to infer the diagnosis in a subset of patients.

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“…Hal ini ditambah dengan gejala klinis meningitis TB seringkali tidak jelas sehingga penegakan diagnosis meningitis TB menjadi sulit. [2][3][4] Marais dkk. 5 telah membuat algoritma dan sistem skoring dalam menegakkan diagnosis meningitis TB.…”

Section: Pendahuluanunclassified

Perbedaan Intensitas Penyengatan Meningeal Hasil MRI antara Sekuens T2 FLAIR Post Contrast dan T1WI Post Contrast Gadolinium-DTPA dalam Mendeteksi Penyangatan Meningeal pada Kasus Meningitis Tuberkulosis

Hendarin¹,

Soetikno²,

Nugraha³

2017

mkb

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AbstrakDiagnosis meningitis TB terutama pada kasus possible dan probable sulit ditegakkan. Pemeriksaan MRI kepala dengan kontras Gadolinium-DTPA adalah modalitas radiologi yang paling sensitif untuk membantu mendiagnosis penyakit ini. Penyangatan meningeal di daerah basal merupakan gambaran MRI yang paling banyak ditemukan pada meningitis TB. Tujuan penelitian ini adalah mengetahui perbedaan peningkatan intensitas sinyal meningen sekuens T2-FLAIR dengan T1WI pada pasien meningitis tuberkulosis menggunakan pemeriksaan MRI kepala dengan kontras Gadolinium-DTPA di RSUP Dr. Hasan Sadikin Bandung pada bulan Januari 2015-Juni 2016. Subjek penelitian sebanyak 21 orang dengan meningitis TB dilakukan pemeriksaan MRI kepala dengan kontras Gadolinium-DTPA. Analisis statistik komparatif dilakukan untuk menguji perbedaan peningkatan intensitas sinyal meningen sekuens T2-FLAIR post contrast dengan T1WI post contrast. Hasil penelitian menujukkan rerata peningkatan intensitas sinyal meningen sekuen T2-FLAIR (∆T2-FLAIR) sebesar 360,59±182,19 aμ sedangkan T1WI (∆T1WI) sebesar 126,47±72,57 aμ. Hasil uji statistik menggunakan uji T pada derajat kepercayaan 95% menunjukkan perbedaan yang bermakna ∆T2-FLAIR dengan ∆T1WI pada nilai p=0,000. Difference between Gadolinium-DTPA Enhanced T2 FLAIR Sequence and T1WI Sequence MRI in Detecting Meningeal Enhancement in Tuberculous Meningitis AbstractThe diagnosis of TB meningitis, especially in possible and probable cases, is difficult. Contrast-enhanced MRI of the head with Gadolinium-DTPA is the most sensitive imaging modality that supports diagnosis of this disease. The most common presentation of TB meningitis in MRI is basal meningeal enhancement. The objective of this study was to determine the difference in the increase of T2-FLAIR and T1WI sequence meningeal signal intensity of in patients with tuberculous meningitis using contrast-enhanced MRI of the head with Gadolinium-DTPA in Dr. Hasan Sadikin General Hospital from January 2015-June 2016. Contrast enhanced MRI examination was conducted in 21 subjects with TB meningitis. Statistical analysis was performed to examine the difference in the increase in meningeal signal intensity of post contrast T2-FLAIR and post contrast T1WI. The result showed that the mean increases in meningeal signal intensity of T2-FLAIR (ΔT2-FLAIR) and T1WI (ΔT1WI) were 360.59±182.19 au and 126.47±72.57 aμ respectively. Statistical test results using T test at 95% confidence level indicated that there was a difference between ΔT2-FLAIR and ΔT1WI at p-value=0.000. In conclusion, the mean increase in meningeal signal intensity of post contrast T2-FLAIR is greater than in the post contrast T1WI in TB meningitis. [MKB. 2017;49(3):172-77]

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British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children

Cited by 493 publications

References 167 publications

Tuberculous Meningitis in Adults: A Review of a Decade of Developments Focusing on Prognostic Factors for Outcome

Tuberculous Meningitis in Adults: A Review of a Decade of Developments Focusing on Prognostic Factors for Outcome

Ring enhancing intracranial lesion responding to antituberculous treatment in an HIV-infected patient

Perbedaan Intensitas Penyengatan Meningeal Hasil MRI antara Sekuens T2 FLAIR Post Contrast dan T1WI Post Contrast Gadolinium-DTPA dalam Mendeteksi Penyangatan Meningeal pada Kasus Meningitis Tuberkulosis

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