Coagulant and Fibrinolytic Status in Tuberculous Meningitis

Schoeman, Johan; Mansvelt, E. P. G.; Springer, Priscilla; Rensburg, André Janse van; Carlini, Sophia; Fourie, Elba

doi:10.1097/01.inf.0000261126.60283.cf

Cited by 43 publications

(28 citation statements)

References 19 publications

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“…In support of these previous findings, our patients with TBM had lower MPV and higher platelet counts compared with those of controls and BM patients. With respect to a possible mechanism explaining our findings, both BM and TBM are associated with an intense inflammatory state (increased oxidative stress, pro-inflammatory cytokine production, and inflammatory cell activation) as well as with a prothrombotic state (endothelial dysfunction, vasculitis, and pro-coagulant mediators) [23][24][25][26]. Longer disease duration in TBM could result in an altered megakaryopoiesis due to chronic exposure to an inflammatory environment.…”

Section: Discussionmentioning

confidence: 88%

Mean platelet volume in the differential diagnosis of tuberculous and bacterial meningitis

Cámara-Lemarroy

Delgado‐García

Cruz-Gonzalez

et al. 2017

J Infect Dev Ctries

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Introduction: Mean platelet volume (MPV) has been shown to reflect the inflammatory burden in different inflammatory and autoimmune diseases. Our objective was to analyze the MPV in patients with tuberculous (TBM) and bacterial meningitis (BM). Methodology: The demographic and clinical data of 73 consecutive patients that presented with either BM (n = 35) or TBM (n = 38) were retrospectively analyzed, as well as that of 28 age-and sex-matched controls. Results: MPV was 8.78 ± 1.58 fL in patients with BM and 6.42 ± 1.39 fL in the TBM group (p < 0.05). In the control group, MPV was 7.4 ± 0.66 fL, significantly higher and lower when compared with TBM and BM, respectively. MPV was significantly associated with diagnosis (adjusted OR: 5.15, 95% CI: 1.090-23.7; p = 0.03). With the optimal cut-off value of 7.62 fL, MPV had 82% sensibility and 78% specificity for the differential diagnosis of TBM versus BM. Lower platelet counts, higher serum creatinine, higher white blood cell counts, and higher blood-cerebrospinal fluid glucose ratio were also predictive of BM. Conclusions: Platelet counts were lower and MPV was higher in patients with BM compared to patients with TBM. Platelet indices, available in routine bloodwork, could be useful in the early differential diagnosis of these entities.

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Section: Discussionmentioning

confidence: 88%

Mean platelet volume in the differential diagnosis of tuberculous and bacterial meningitis

Cámara-Lemarroy

Delgado‐García

Cruz-Gonzalez

et al. 2017

J Infect Dev Ctries

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“…The use of aspirin has been researched in TBM, since it is antithrombotic and possibly neuroprotective. Children with TBM and adults with pulmonary TB have been shown to have hypercoagulation, which may contribute to the development of ischemia [102]. However, a study performed in children with TBM showed no significant effect on either mortality or neurological deficits with either low-or high-dose aspirin regimens [103].…”

Section: Strokementioning

confidence: 90%

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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“…A hypercoagulable state in TBM has been reported and may increase the risk of infarction [47]. There is a decrease of anticoagulant (Protein S) and an increase of procoagulant factor (Factor VIII).…”

Section: Coagulation and Fibrinolytic Status In Tuberculous Meningitismentioning

confidence: 99%

“…This hypercoagulable state is more pronounced in stage III than in stage II TBM. These changes in procoagulant, antithrombotic, fibrinolytic, platelet and vascular endothelial functions could contribute to increased risk of thrombosis and infarction [47].…”

Section: Coagulation and Fibrinolytic Status In Tuberculous Meningitismentioning

confidence: 99%

Stroke in tuberculous meningitis

Misra

Maurya

2011

Journal of the Neurological Sciences

163

152

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Coagulant and Fibrinolytic Status in Tuberculous Meningitis

Abstract: The hypercoagulable state in childhood TBM is comparable to that described in adults with pulmonary tuberculosis and may further increase the risk for infarction. Therapeutic measures that reduce the risk for thrombosis could therefore be potentially beneficial in childhood TBM.

Cited by 43 publications

References 19 publications

Mean platelet volume in the differential diagnosis of tuberculous and bacterial meningitis

Mean platelet volume in the differential diagnosis of tuberculous and bacterial meningitis

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

Stroke in tuberculous meningitis

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