Six months therapy for abdominal tuberculosis

Jullien, Sophie; Jain, Siddharth; Ryan, Hannah; Ahuja, Vineet

doi:10.1002/14651858.cd012163

Cited by 16 publications

(1 citation statement)

References 13 publications

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“…All patients received standard WHO-recommended TBM treatment with isoniazid (300 mg/d), rifampicin (450-600 mg/d), pyrazinamide (20-30 mg/kg/d), and ethambutol (15-20 mg/kg/d) orally during the 2-month intensive phase (World Health Organization, 2010;Thwaites, 2013), with isoniazid and rifampicin during the 7-12 month continuation phase (Thwaites, 2013;Thwaites et al, 2013;Jullien et al, 2016;Falzon et al, 2017). Intravenous dexamethasone (0.4 mg/kg/day) or oral prednisone (40 mg/day) was given for severe disease at baseline (judged by the treating clinician), if a patient's condition worsened after the start of treatment (Gilpin et al, 2018;Mirzayev et al, 2021).…”

Section: Clinical Datamentioning

confidence: 99%

Disease spectrum and prognostic factors in patients treated for tuberculous meningitis in Shaanxi province, China

Wang,

Li,

Cai

et al. 2024

Front. Microbiol.

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BackgroundTuberculous meningitis (TBM) is the most severe form of tuberculosis (TB) and can be difficult to diagnose and treat. We aimed to describe the clinical presentation, diagnosis, disease spectrum, outcome, and prognostic factors of patients treated for TBM in China.MethodsA multicenter retrospective study was conducted from 2009 to 2019 enrolling all presumptive TBM patients referred to Xijing tertiary Hospital from 27 referral centers in and around Shaanxi province, China. Patients with clinical features suggestive of TBM (abnormal CSF parameters) were included in the study if they had adequate baseline information to be classified as “confirmed,” “probable,” or “possible” TBM according to international consensus TBM criteria and remained in follow-up. Patients with a confirmed alternative diagnosis or severe immune compromise were excluded. Clinical presentation, central nervous system imaging, cerebrospinal fluid (CSF) results, TBM score, and outcome—assessed using the modified Barthel disability index—were recorded and compared.FindingsA total of 341 presumptive TBM patients met selection criteria; 63 confirmed TBM (25 culture positive, 42 Xpert-MTB/RIF positive), 66 probable TBM, 163 possible TBM, and 49 “not TBM.” Death was associated with BMRC grade III (OR = 5.172; 95%CI: 2.298–11.641), TBM score ≥ 15 (OR = 3.843; 95%CI: 1.372–10.761), age > 60 years (OR = 3.566; 95%CI: 1.022–12.442), and CSF neutrophil ratio ≥ 25% (OR = 2.298; 95%CI: 1.027–5.139). Among those with confirmed TBM, nearly one-third (17/63, 27.0%) had a TBM score < 12; these patients exhibited less classic meningitis symptoms and signs and had better outcomes compared with those with a TBM score ≥ 12. In this group, signs of disseminated/miliary TB (OR = 12.427; 95%CI: 1.138–135.758) and a higher TBM score (≥15, OR = 8.437; 95%CI: 1.328–53.585) were most strongly associated with death.ConclusionTBM patients who are older (>60 years) have higher TBM scores or CSF neutrophil ratios, have signs of disseminated/miliary TB, and are at greatest risk of death. In general, more effort needs to be done to improve early diagnosis and treatment outcome in TBM patients.

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