HHH Regime for Arteritis Secondary to TB Meningitis: A Prospective Randomized Study

Gujjar, Arunodaya R.; Srikanth, S. G.; Gs, Rao

doi:10.1007/s12028-008-9182-8

Cited by 12 publications

(5 citation statements)

References 9 publications

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“…63,66,68 A small preliminary study has tentatively suggested that a hypervolaemiae hyperfusionehaemodilution (HHH) regime used in the treatment of vasospasm complicating subarachnoid haemorrhage (SAH) may improve focal deficits and altered mental status in patients with TBM and arteritis. 91 The study was predicated on the hypothesis that arteritis in TBM resembles this complication of SAH syndromically and pathologically e both are basal meningeal disorders with similarities in perforating vessel pathology and resulting ischaemia. The results were equivocal but merit further investigation.…”

Section: Treatmentmentioning

confidence: 99%

Tuberculous cerebrovascular disease: A review

Lammie¹,

Hewlett²,

Schoeman³

et al. 2009

Journal of Infection

138

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Section: Treatmentmentioning

confidence: 99%

Tuberculous cerebrovascular disease: A review

Lammie¹,

Hewlett²,

Schoeman³

et al. 2009

Journal of Infection

138

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“…Triple H therapy (hypervolemia, hypertension, and hemodilution) is effective for arteritis secondary to tuberculous meningitis, 7) and administration of corticosteroid and/or antibiotics is effective. 20,23) In our case, the clinical symptoms progressed despite antibiotic administration with hypervolemic therapy, hyperdynamic therapy, and corticosteroid administration.…”

Section: Discussionmentioning

confidence: 99%

Cerebral Arteritis With Extremely Late Onset Secondary to Bacterial Meningitis -Case Report-

Kawaguchi

Ogawa

Inoue

et al. 2011

Neurol. Med. Chir.(Tokyo)

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A 59-year-old woman presented with bacterial meningitis causing arterial narrowing in the very late stage. She initially underwent transsphenoidal surgery for massive non-functioning pituitary adenoma resulting in gross total removal. The postoperative course was uneventful, and she was discharged 12 days after surgery. Fourteen months later, she presented with bacterial meningitis due to streptococcus. Administration of multiple antibiotics resulted in normalization of cerebrospinal fluid findings. Forty days after meningitis onset, she suddenly suffered motor weakness of the right extremities. Magnetic resonance (MR) angiography revealed multiple intracranial arterial narrowings. Despite intensive treatment, no improvement of arterial narrowing was seen, and she suffered cerebral infarction. Six months after the onset of meningitis, MR angiography still showed multiple arterial narrowings, and MR plaque imaging of the stenotic vessel disclosed thickened arterial wall. This case illustrates the complex time course of arteritis caused by severe bacterial meningitis, and the intractability to treatment.

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“…These different options need to be addressed. Few trials have been conducted evaluating high doses of rifampicin and use of fluoroquinolones for TBM (Heemskerk 2016; Ruslami 2013; Thwaites 2011). However, these trials assessed survival as main outcome and did not follow-up participants after completion of ATT for relapse.…”

Section: Authors' Conclusionmentioning

confidence: 99%

Six months therapy for tuberculous meningitis

Jullien¹,

Ryan

Modi

et al. 2016

Cochrane Database of Systematic Reviews

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BackgroundTuberculous meningitis (TBM) is the main form of tuberculosis that affects the central nervous system and is associated with high rates of death and disability. Most international guidelines recommend longer antituberculous treatment (ATT) regimens for TBM than for pulmonary tuberculosis disease to prevent relapse. However, longer regimens are associated with poor adherence, which could contribute to increased relapse, development of drug resistance, and increased costs to patients and healthcare systems.ObjectivesTo compare the effects of short-course (six months) regimens versus prolonged-course regimens for people with tuberculous meningitis (TBM).Search methodsWe searched the following databases up to 31 March 2016: the Cochrane Infectious Diseases Group Specialized Register; the Cochrane Central Register of Controlled Trials (CENTRAL), published in the Cochrane Library; MEDLINE; EMBASE; LILACS; INDMED; and the South Asian Database of Controlled Clinical Trials. We searched the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov for ongoing trials. We also checked article reference lists and contacted researchers in the field.Selection criteriaWe included randomized controlled trials (RCTs) and prospective cohort studies of adults and children with TBM treated with antituberculous regimens that included rifampicin for six months or longer than six months. The primary outcome was relapse, and included studies required a minimum of six months follow-up after completion of treatment.Data collection and analysisTwo review authors (SJ and HR) independently assessed the literature search results for eligibility, and performed data extraction and 'Risk of bias' assessments of the included studies. We contacted study authors for additional information when necessary. Most data came from single arm cohort studies without a direct comparison so we pooled the findings for each group of cohorts and presented them separately using a complete-case analysis. We assessed the quality of the evidence narratively, as using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was inappropriate with no direct comparisons between short- and prolonged-course regimens.Main resultsFour RCTs and 12 prospective cohort studies met our inclusion criteria, and included a total of 1881 participants with TBM. None of the included RCTs directly compared six months versus longer regimens, so we analysed all data as individual cohorts to obtain relapse rates in each set of cohorts.We included seven cohorts of participants treated for six months, with a total of 458 participants. Three studies were conducted in Thailand, two in South Africa, and one each in Ecuador and Papua New Guinea between the 1980s and 2009. We included 12 cohorts of participants treated for longer than six months (ranging from eight to 16 months), with a total of 1423 participants. Four studies were conducted in India, three in Thailand and one each in China, South Africa,...

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HHH Regime for Arteritis Secondary to TB Meningitis: A Prospective Randomized Study

Abstract: HHH therapy is safe and may be beneficial in the management of patients with infective arteritis secondary to TBM. Further study in a larger group with improved monitoring of cerebral circulation is indicated.

Cited by 12 publications

References 9 publications

Tuberculous cerebrovascular disease: A review

Tuberculous cerebrovascular disease: A review

Cerebral Arteritis With Extremely Late Onset Secondary to Bacterial Meningitis -Case Report-

Six months therapy for tuberculous meningitis

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