Paradoxical reaction in HIV negative tuberculous meningitis

Garg, Ravindra Kumar; Malhotra, Hardeep Singh; Kumar, Neeraj

doi:10.1016/j.jns.2014.03.025

Cited by 81 publications

(85 citation statements)

References 114 publications

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“…High doses of corticosteroids are currently the most preferred treatment. Many other immunomodulatory drugs like, tissue necrosis factor-α antagonists, thalidomide, and interferon-γ have also been used, though sparingly [3]. There were certain limitations of our study.…”

Section: Discussionmentioning

confidence: 95%

“…A paradoxical reaction was defined as the worsening of pre-existing tuberculous lesions or the appearance of new tuberculous lesions in patients whose clinical symptoms initially improved and had been on antituberculosis treatment for at least 10 days [2,3,11]. For the purpose of the calculation of "time of onset of paradoxical reaction" in the study participants only clinical deteriorations were considered from the time of initiation of anti-tuberculosis treatment; nonsymptomatic radiological worsening was defined either at the time of clinical deteriorations or at the predefined follow-up visit.…”

Section: Definition Of Paradoxical Reactionmentioning

confidence: 99%

“…The clinical or radiological deterioration associated with such a reaction may fallaciously suggest either a drug resistant state or treatment failure, and might even prompt to look for an alternative diagnosis [1][2][3]. The manifestations of paradoxical reaction, that have been described, are mostly derived from case reports and small case series.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Miliary Tuberculosis Mimicking Brain Metastasis from Renal Cell Carcinoma

Park

et al. 2018

J Neurocrit Care

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Background: Awareness about paradoxical reactions in tuberculous meningitis is crucial as a paradoxical reaction may lead to certain wrong conclusions (for example, an erroneous diagnosis, and a possibility of treatment failure, mycobacterial drug-resistance, drug toxicity, or presence of a malignancy). The present study was planned to evaluate the incidence and predictive factors of paradoxical reactions in light of clinical, cerebrospinal fluid, and neuroimaging characteristics. Methods: In this prospective cohort study, consecutive patients fulfilling the International Consensus criteria of tuberculous meningitis were included. Patients were subjected to clinical evaluation, cerebrospinal fluid evaluation, and neuroimaging. Patients were treated with anti-tuberculosis drugs along with corticosteroids. Patients were regularly followed up at 3 monthly intervals. At each follow up patients were evaluated clinically and repeat cerebrospinal fluid analysis was performed along with repeat neuroimaging. Disability assessment was done using Barthel index. Results: We enrolled 141 patients of tuberculous meningitis. Approximately one-third of patients (44/141; 31.2 %) developed a paradoxical reaction. Twenty-seven patients developed hydrocephalus, 26 developed tuberculomas, 12 developed optochiasmatic arachnoiditis and 4 patients had spinal arachnoiditis. In 41 patients (out of 44) cerebrospinal fluid paradoxically worsened (increase in cells and/or protein); 2 demonstrated a decrease in cells with polymorph predominance while in one it was normal. In 3 patients, paradoxical cerebrospinal fluid changes were not associated with neuroimaging changes. On multivariate analysis, predictors of paradoxical reaction were female gender (p = 0.013), HIV positivity (p = 0.01) and a shorter duration of illness (p = 0.049). Development of paradoxical reactions did not predict the disability status of the patients.Conclusions: Paradoxical reaction occurs in approximately one-third of patients with tuberculous meningitis. Female gender, concomitant HIV infection, and a shorter duration of illness were significant predictors. Paradoxical reactions did not adversely affect the outcome.

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Section: Discussionmentioning

confidence: 95%

Section: Definition Of Paradoxical Reactionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Miliary Tuberculosis Mimicking Brain Metastasis from Renal Cell Carcinoma

Park

et al. 2018

J Neurocrit Care

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“…2 Researchers believe this to be an exacerbation of the immune response to the M tuberculosis antigen when effective anti-tuberculous treatment is initiated. 3 Constitutional symptoms like fever, malaise and weight loss can develop along with worsening of existing radiographic abnormalities, which can progress to severe respiratory distress and adult respiratory distress syndrome in rare cases. Paradoxical reaction following anti-tuberculous treatment is common in both HIV and non-HIV infected individuals.…”

Section: Discussionmentioning

confidence: 99%

Paradoxical reaction in the form of pleural effusion after onset of anti-tuberculous medication for tubercular lymphadenitis

Bhattacharya¹,

Mukherjee

2017

Clinical Medicine

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“…This is the development of new lesions or worsening of pre-existing tuberculous lesions in a patient who initially improves with treatment; it probably represents an interplay between immune reconstitution and an exaggerated immune response to released mycobacterial antigens 23. This phenomenon may occur from 2 weeks to 27 months after starting treatment 24.…”

Section: Discussionmentioning

confidence: 99%

Tuberculous tales: an East London experience

et al. 2017

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Tuberculous meningitis presents a diagnostic and therapeutic challenge, and considering its long history and increasing global incidence, the evidence base for its treatment is relatively scanty. Many UK neurologists will have little first-hand experience of this deadly condition, and if faced with a patient with possible tuberculous meningitis will find decision making less than straightforward. In parts of East London (UK) the rates of tuberculosis and tuberculous meningitis are among the highest in Western Europe, and so the neurologists and respiratory physicians at the Royal London Hospital have encountered many such patients over the years. We have found experience to be a valuable teacher and so would like to share five cases that illustrate the complexities of diagnosis and management of the disease, and complications of its treatment.

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Paradoxical reaction in HIV negative tuberculous meningitis

Cited by 81 publications

References 114 publications

Miliary Tuberculosis Mimicking Brain Metastasis from Renal Cell Carcinoma

Miliary Tuberculosis Mimicking Brain Metastasis from Renal Cell Carcinoma

Paradoxical reaction in the form of pleural effusion after onset of anti-tuberculous medication for tubercular lymphadenitis

Tuberculous tales: an East London experience

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