The neurocritical care of tuberculous meningitis

Donovan, Joseph; Figaji, Anthony; Imran, Darma; Phu, Nguyen Hoan; Rohlwink, Ursula K.; Thwaites, Guy

doi:10.1016/s1474-4422(19)30154-1

Cited by 98 publications

(69 citation statements)

References 83 publications

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“…The syndrome of inappropriate antidiuretic hormone secretion and cerebral salt wasting are considered the most likely causes of hyponatremia in patients with TBM and could overlap 9 . Hyponatremia can develop anytime during TBM 8 , and worsens cerebral edema, headache, confusion, seizures, and coma 12 , and predicts increased mortality in patients particularly with human immunode ciency virus (HIV) infections and TBM 13 . However, to the best of our knowledge, the cross-sectional or longitudinal comparison according to various infectious meningitis etiologies has not been previously performed, although diagnosing TBM is one of the most challenging differential diagnoses and the cost of a false-negative diagnosis is fatal.…”

Section: Discussionmentioning

confidence: 99%

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The association between serum sodium levels and tuberculous meningitis compared to viral and bacterial meningitis: Multicenter retrospective cohort study

Kim

Song

et al. 2021

Preprint

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We evaluated the association between hyponatremia and tuberculous meningitis (TBM) in hopes of providing additional information for the differential diagnosis of TBM from other types of infectious meningitis, especially from viral meningitis (VM). Cross-sectional and longitudinal data involving 5,026 participants more than 18 years of age were analyzed in the total population and the propensity-matched population. The initial and lowest sodium levels and longitudinal changes in TBM, VM, and bacterial meningitis (BM) patients were compared. The initial serum sodium levels were significantly lower in the TBM patients than in the VM and BM patients (136.9 ± 5.9 vs. 139.0 ± 3.1, p < 0.001 for TBM vs. VM, and 138.3 ± 4.7 mmol/L and p < 0.001 for TBM vs. BM) and it dropped significantly more steeply to lower levels in both the TBM and BM patients compared to the VM patients. Consequently, the lowest serum sodium levels were in the order of the TBM < BM < VM patients, which were also statistically significant in all subgroups. (131.8 ± 6.4, 133.1 ± 5.1, 137.4 ± 3.7, respectively, p < 0.001). The participants with lower serum sodium levels were more likely to have a diagnosis of TBM rather than VM, and this association was more pronounced for the lowest sodium levels than the initial sodium levels (OR 8.4 (95% CI: 4.5–15.8, p < 0.001)). The baseline and longitudinal evaluation of serum sodium levels can provide supportive information for the differential diagnosis of TBM from VM or BM.

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Section: Discussionmentioning

confidence: 99%

“…It is common in patients with traumatic brain injury, subarachnoid hemorrhage, and brain tumors, and patients who underwent intracranial procedures 7 . Hyponatremia has been also reported to be associated with septic meningitis including bacterial meningitis (BM) and TBM [8][9][10] .…”

Section: Introductionmentioning

confidence: 99%

The association between serum sodium levels and tuberculous meningitis compared to viral and bacterial meningitis: Multicenter retrospective cohort study

Kim

Song

et al. 2021

Preprint

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“…The pathophysiology of raised ICP in TB meningitis is complex. Hydrocephalus, inflammatory paradoxical reactions, neurological immune reconstitution inflammatory syndrome [IRIS], and cerebral oedema can all contribute to raised ICP, with the latter exacerbated by hyponatraemia [ 31 , 32 ]. Raised ICP is common in cerebral malaria especially among children.…”

Section: Pathophysiology Of Raised Intracranial Pressure In Brain Infmentioning

confidence: 99%

The role of optic nerve sheath diameter ultrasound in brain infection

et al. 2021

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Brain infections cause significant morbidity and mortality worldwide, especially in resource-limited settings with high HIV co-infection rates. Raised intracranial pressure [ICP] may complicate brain infection and worsen neurological injury, yet invasive ICP monitoring is often unavailable. Optic nerve sheath diameter [ONSD] ultrasound may allow detection of raised ICP at the bedside; however, pathology in brain infection is different to traumatic brain injury, in which most studies have been performed. The use of ONSD ultrasound has been described in tuberculous meningitis, cryptococcal meningitis and cerebral malaria; however correlation with invasive ICP measurement has not been performed. Normal optic nerve sheath values are not yet established for most populations, and thresholds for clinical intervention cannot be assumed to match those used in non-infective brain pathology. ONSD ultrasound may be suitable for use in resource-limited settings by clinicians with limited ultrasound training. Standardisation of scanning technique, consensus on normal ONSD values, and action on abnormal results, are areas for future research. This scoping review examines the role of ONSD ultrasound in brain infection. We discuss pathophysiology, and describe the rationale, practicalities, and challenges of utilising ONSD ultrasound for brain infection monitoring and management. We discuss the existing evidence base for this technique, and identify knowledge gaps and future research priorities.

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“…It is common in patients with traumatic brain injury, subarachnoid hemorrhage, and brain tumors as well as patients who have undergone intracranial procedures 10 . Hyponatremia has been reported to be associated with septic meningitis including bacterial meningitis (BM) and TBM 11 – 13 .…”

Section: Introductionmentioning

confidence: 99%

The association between serum sodium level and tuberculous meningitis compared with viral and bacterial meningitis

Kim

Song

et al. 2021

Sci Rep

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We evaluated the association between hyponatremia and tuberculous meningitis (TBM) with the aim of providing additional information for differential diagnosis from other types of infectious meningitis, especially viral meningitis (VM). Cross-sectional and longitudinal data involving 5026 participants older than 18 years were analyzed in the total population and a propensity-matched population. The initial and lowest sodium levels and longitudinal changes in TBM, bacterial meningitis (BM), and VM patients were compared. Participants in the TBM group were enrolled when they were diagnosed as possible, probable, or definite TBM according to the Marais’ criteria. The initial serum sodium level was significantly lower in TBM patients than in BM and VM patients (136.9 ± 5.9 vs. 138.3 ± 4.7 mmol/L, p < 0.001 for TBM vs. BM, and 139.0 ± 3.1, p < 0.001 for TBM vs. VM), and it decreased significantly more steeply to lower levels in both the TBM and BM patients compared with VM patients. The lowest serum sodium level was in the order of TBM < BM < VM patients, and the change was statistically significant in all subgroups (131.8 ± 6.4, 133.1 ± 5.1, 137.4 ± 3.7, respectively, p < 0.001). Participants with lower serum sodium level were more likely to have a diagnosis of TBM rather than VM, and this association was more pronounced for the lowest sodium level than the initial sodium level [OR 4.6 (95% CI 2.4–8.8, p < 0.001)]. These findings indicate that baseline and longitudinal evaluation of serum sodium level can provide information for differential diagnosis of TBM from BM or VM.

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The neurocritical care of tuberculous meningitis

Cited by 98 publications

References 83 publications

The association between serum sodium levels and tuberculous meningitis compared to viral and bacterial meningitis: Multicenter retrospective cohort study

The association between serum sodium levels and tuberculous meningitis compared to viral and bacterial meningitis: Multicenter retrospective cohort study

The role of optic nerve sheath diameter ultrasound in brain infection

The association between serum sodium level and tuberculous meningitis compared with viral and bacterial meningitis

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