Multidrug-resistant tuberculous meningitis

Byrd, Thomas F.; Davis, Larry E.

doi:10.1007/s11910-007-0073-8

Cited by 24 publications

(19 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Because of multidrug-resistant strains, tuberculous meningitis was more frequent in patients who received irregular antituberculosis treatment [59,60]. Patients with multidrug-resistant tuberculous meningitis and HIV-infection have lower cure rates and higher mortality rates than patients with drug-susceptible tuberculous meningitis, and most patients die within 3 months [26,61].…”

Section: Drug-resistant Tuberculous Meningitis In Hiv-positive Patientsmentioning

confidence: 99%

Tuberculous meningitis in patients infected with human immunodeficiency virus

Garg

Sinha

2010

J Neurol

View full text Add to dashboard Cite

Tuberculosis is the most common opportunistic infection in human immunodeficiency virus (HIV) infected persons. HIV-infected patients have a high incidence of tuberculous meningitis as well. The exact incidence and prevalence of tuberculous meningitis in HIV-infected patients are not known. HIV infection does not significantly alter the clinical manifestations, laboratory, radiographic findings, or the response to therapy. Still, some differences have been noted. For example, the histopathological examination of exudates in HIV-infected patients shows fewer lymphocytes, epithelioid cells, and Langhan's type of giant cells. Larger numbers of acid-fast bacilli may be seen in the cerebral parenchyma and meninges. The chest radiograph is abnormal in up to 46% of patients with tuberculous meningitis. Tuberculous meningitis is likely to present with cerebral infarcts and mass lesions. Cryptococcal meningitis is important in differential diagnosis. The recommended duration of treatment in HIV-infected patients is 9-12 months. The benefit of adjunctive corticosteroids is uncertain. Antiretroviral therapy and antituberculosis treatment should be initiated at the same time, regardless of CD4 cell counts. Tuberculous meningitis may be a manifestation of paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome. Some studies have demonstrated a significant impact of HIV co-infection on mortality from tuberculous meningitis. HIV-infected patients with multidrug-resistant tuberculous meningitis have significantly higher mortality. The best way to prevent HIV-associated tuberculous meningitis is to diagnose and isolate infectious cases of tuberculosis promptly and administer appropriate treatment.

show abstract

Section: Drug-resistant Tuberculous Meningitis In Hiv-positive Patientsmentioning

confidence: 99%

Tuberculous meningitis in patients infected with human immunodeficiency virus

Garg

Sinha

2010

J Neurol

View full text Add to dashboard Cite

show abstract

“…The widespread ongoing implementation of GeneXpertMTB/RIF (Cepheid) in high-TBburden settings may enable rapid diagnosis of MDR-TBM, but data are not yet available on the accuracy of the technique in TBM cases. Even if the diagnosis of drug-resistant TBM were to be confirmed, there are no data from RCTs to guide clinical management (2,5).…”

Section: Discussionmentioning

confidence: 99%

“…In resource-limited high-TB-burden settings, drug-resistant TBM is rarely diagnosed within a clinically useful time frame, owing to the difficulty of isolating organisms from the paucibacillary cerebrospinal fluid (CSF), the lack of laboratory capacity for M. tuberculosis culture, and the slow growth of the organism. MDR-TBM is almost universally fatal in the developing world (2,20), but there are few data regarding the impact of other forms of drug resistance on outcome.…”

mentioning

confidence: 99%

Influence of Antituberculosis Drug Resistance and Mycobacterium tuberculosis Lineage on Outcome in HIV-Associated Tuberculous Meningitis

Tho

Török

Yen³

et al. 2012

Antimicrob Agents Chemother

View full text Add to dashboard Cite

“…The convergence of drug-resistant TB and HIV poses unique clinical challenges [1][2][3] ; among these, involvement of the central nervous system (CNS) presents one of the most difficult manifestations, with significant morbidity and mortality. [4][5][6][7] The emergence of HIV and drug-resistant TB as relentless forces in the TB epidemic has accelerated the push for innovative TB diagnostics. [8][9][10][11] The ideal method must diagnose TB from smear-negative specimens, identify resistance to at least INH and RIF, and perform under basic laboratory conditions at minimal cost.…”

Section: Discussionmentioning

confidence: 99%

Challenges of Diagnosis and Management of Tuberculosis and HIV Coinfection in Resource-Limited Settings: A Case Report from Lima, Peru

Rojas

Solari

Herrera³

et al. 2008

Journal of the International Association of Physicians in AIDS

View full text Add to dashboard Cite

We present a Peruvian human immunodeficiency virus (HIV)-positive patient receiving first-line therapy for tuberculosis who presents with neurological complications to highlight some of the major issues in the diagnosis and management of human immunodeficiency virus-related central nervous system complications in resource-poor settings. These include limited options for diagnosing extrapulmonary and drug-resistant tuberculosis; the importance of central nervous system imaging; and the management conundrum when faced with a broad differential diagnosis. This patient was diagnosed with drug-resistant tuberculosis of the skin, and we felt that his neurologic syndrome was consistent with drug-resistant tuberculosis of the brain, unmasked by immunologic recovery in the setting of recent initiation of antiretroviral treatment. We argue that aggressive and timely empiric multidrug-resistant tuberculosis treatment is important in cases where drug-resistant tuberculosis is suspected. Knowledge gaps include a limited understanding of immune reconstitution and the optimal timing of antiretroviral treatment in the setting of drug-resistant tuberculosis.

show abstract

Multidrug-resistant tuberculous meningitis

Cited by 24 publications

References 42 publications

Tuberculous meningitis in patients infected with human immunodeficiency virus

Tuberculous meningitis in patients infected with human immunodeficiency virus

Influence of Antituberculosis Drug Resistance and Mycobacterium tuberculosis Lineage on Outcome in HIV-Associated Tuberculous Meningitis

Challenges of Diagnosis and Management of Tuberculosis and HIV Coinfection in Resource-Limited Settings: A Case Report from Lima, Peru

Contact Info

Product

Resources

About