Central nervous system tuberculosis

Abstract

Purpose of review Central nervous system (CNS) tuberculosis is the most devastating form of tuberculosis (TB), with mortality and or neurological sequelae in over half of individuals. We reviewed original research and systematic reviews published since 1 January 2019 for new developments in CNS TB pathophysiology, diagnosis, management and prognosis. Recent findings Insight in the pathophysiology is increasing steadily since the landmark studies in 1933, focussing on granuloma type classification, the relevance of the M. tuberculosis bacterial burden and the wide range of immunological responses. Although Xpert/RIF has been recommended by the WHO for extrapulmonary TB diagnosis, culture is still needed to increase the sensitivity of TB meningitis diagnosis. Sequential MRIs can improve understanding of neurological deficits at baseline and during treatment. Pharmacokinetic/pharmacodynamic modelling suggests that higher doses of rifampicin and isoniazid in TB meningitis could improve survival. Summary Recent studies in the field of CNS-TB have largely focussed on TB meningitis. The outcome may improve by optimizing treatment dosing. This needs to be confirmed in clinical trials. Due to the important role of inflammation, these trials should be used as the platform to study the inflammatory and metabolomic responses. This could improve understanding of the biology of this disease and improve patient outlook by enabling individualised host-directed therapy.

Disseminated tuberculosis in an immunocompetent woman from the Himalayan region of Nepal: A case report

“…Small tuberculous lesions known as Rich's foci, formed in the cerebral cortex, cerebral parenchyma, or spinal cord, may remain dormant for several years. Rupture of these foci leads to the spread of the bacilli into the subarachnoid space, resulting in tuberculous meningitis 11 . Risk factors of miliary TB and extrapulmonary TB include HIV, diabetes mellitus, smoking, alcohol abuse, malnutrition, and overcrowding, which were absent in our patient 8,12 .…”

Cerebral tuberculoma in pregnant women: A systematic review and comprehensive analysis of literature

“…CNS TB accounts for about 1% of all TB cases and 8% of extrapulmonary TB cases. Their rarity, combined with the complex presentation and management needs during pregnancy, underscores the need for focused research in this area 20 . Historical documentation since 1898 highlights the ongoing challenge of diagnosing and managing brain tumors, including tuberculomas, in pregnant women.…”

Isoniazid dose-related prediction model for patients with tuberculosis meningitis in southwest China

“…This is much lower than the 10mg/kg/day dose recommended in the guidelines for the treatment of tuberculosis meningitis in children [4]. Several studies have shown that lower isoniazid exposure or lower dose of isoniazid is associated with a high risk of death in patients with tuberculosis meningitis [5,6], and pharmacokinetic studies suggest increasing isoniazid doses [7]. However, the optimal isoniazid dose recommended to treat adults with tuberculosis meningitis is currently inconclusive.…”