Treatment guidelines for tuberculosis and tuberculous meningitis

Cresswell, Fiona V; Musubire, Abdu K; Århem, Katarina M. Johansson

doi:10.1016/b978-0-12-818825-5.00006-1

Cited by 4 publications

(4 citation statements)

References 72 publications

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“…The use of steroid may therefore reduce neurological impairment and death. The anti-seizure phenytoin is taken to control seizures in TBM, while the diuretics acetazolamide and furosemide can be used to manage raised intracranial pressure in TBM (249). Illustration created with Biorender.com.…”

Section: Mmp Inhibition As Potential Developments In the Field Of Therapeuticsmentioning

confidence: 99%

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Neutrophil-Mediated Immunopathology and Matrix Metalloproteinases in Central Nervous System – Tuberculosis

et al. 2022

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Tuberculosis (TB) remains one of the leading infectious killers in the world, infecting approximately a quarter of the world’s population with the causative organism Mycobacterium tuberculosis (M. tb). Central nervous system tuberculosis (CNS-TB) is the most severe form of TB, with high mortality and residual neurological sequelae even with effective TB treatment. In CNS-TB, recruited neutrophils infiltrate into the brain to carry out its antimicrobial functions of degranulation, phagocytosis and NETosis. However, neutrophils also mediate inflammation, tissue destruction and immunopathology in the CNS. Neutrophils release key mediators including matrix metalloproteinase (MMPs) which degrade brain extracellular matrix (ECM), tumor necrosis factor (TNF)-α which may drive inflammation, reactive oxygen species (ROS) that drive cellular necrosis and neutrophil extracellular traps (NETs), interacting with platelets to form thrombi that may lead to ischemic stroke. Host-directed therapies (HDTs) targeting these key mediators are potentially exciting, but currently remain of unproven effectiveness. This article reviews the key role of neutrophils and neutrophil-derived mediators in driving CNS-TB immunopathology.

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Section: Mmp Inhibition As Potential Developments In the Field Of Therapeuticsmentioning

confidence: 99%

“…To date, the three major HDTs being investigated for CNS-TB management are steroids, aspirin and anti-TNF-α agents ( Figure 8 ). Clinical features of TBM such as seizure and raised intracranial pressure may require drugs such as anti-epileptics, diuretics acetazolamide and furosemide ( 249 ).…”

Section: Adjunctive Therapy For Cns-tbmentioning

confidence: 99%

Neutrophil-Mediated Immunopathology and Matrix Metalloproteinases in Central Nervous System – Tuberculosis

et al. 2022

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“…Afghanistan follows the WHO-recommended treatment for drug-sensitive TBM for adults and children, which consists of a four-drug regimen (isoniazid, rifampicin, pyrazinamide and ethambutol) for 2 mo, followed by 7–10 mo of rifampicin and isoniazid 27 , 28 with high dose adjunctive dexamethasone, tapered over 6–8 wk. 27 Evidence supporting the use of dexamethasone in adults is small but of high quality, 29 while, for children, the evidence is weaker and is based on smaller randomised trials with supportive findings from observational studies.…”

Section: Introductionmentioning

confidence: 99%

Treatment outcomes and risk factors of death in childhood tuberculous meningitis in Kandahar, Afghanistan: a prospective observational cohort study

Rahimi

Niazi

Rahimi

et al. 2022

Transactions of the Royal Society of Tropical Medicine and Hygiene

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Background Tuberculous meningitis (TBM) is the most severe form of TB. We prospectively documented the treatment outcomes and the risk factors for death in children with TBM from Kandahar, Afghanistan. Methods This prospective observational cohort study was conducted from February 2017 to January 2020 in hospitalised TBM children. All the patients were prospectively followed up for 12 mo. Data were analysed by using descriptive statistics, χ2 and multivariate logistic regression. Results A total of 818 TBM hospitalised patients with median age 4.8 (0.8–14.5) y were recruited. Females accounted for 60.9% (498/818). Upon admission 53.9% (n=441) and 15.2% (n=124) had TBM stages II and III, respectively, and 23.2% (n=190) had focal neurological signs. The case fatality rate was 20.2% (160/794) and 30.6% (243/794) survived with neurological sequelae. Independent risk factors for death were being unvaccinated for BCG (adjusted OR [AOR] 3.8, 95% CI 1.8 to 8.1), not receiving dexamethasone (AOR 2.5, 95% CI 1.5 to 4.2), being male (AOR 2.3, 95% CI 1.5 to 3.6), history of recent weight loss (AOR 2.2, 95% CI 1.3 to 3.9) and having stage III TBM (AOR 2.0, 95% CI 1.2 to 3.3). Conclusions TBM continues to cause high morbidity and mortality in Afghan children. Strategies to reduce mortality should emphasise early diagnosis and treatment, routine use of dexamethasone and increased BCG vaccination.

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“…Bacterial meningitis can result in vasculitis of the cerebral vessels, resulting in thrombosis and an ischemic stroke. The most prevalent clinical complication of TBM-induced cerebral infarction is hemiplegia (Cresswell et al, 2020). The specific mechanism between malnutrition and tuberculosis is uncertain, however, under nutrition is a risk factor for the disease (Patel and Detjen, 2017).…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of preliminary physiotherapy intervention in a child with tubercular meningitis along with acute ischemic infarct

Somaiya¹,

Kovela²,

Harjpal³

2022

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Acute bacterial meningitis (ABM) is a condition with a high incidence, high fatality and morbidity rates. The phenomenon Hydrocephalus, periventricular infarcts, optochiasmatic and spinal arachnoiditis, and tuberculous mass lesions in the brain are just a few of the consequences associated with tuberculous meningitis. We conducted a full neuro physiotherapy evaluation.We developed a rehabilitation program based on the data, which proved to be highly efficient in improving the child's condition and functional abilities.They had been complaining of fever for 1.5 months, decreased oral intake for 7 days, and tightness in all limbs with difficulty utilising the right upper and lower leg for 7 days when they came to see us. The child was also unable to communicate with a left-sided facial deviation. According to all tests, the patient acquired Tuberculous Meningitis with an acute cerebral infarct on the left side, resulting in right side hemiplegia and communicating hydrocephalus. The child's functional ability was greatly enhanced as a result of the physiotherapy rehabilitation we used. The facial muscle strength had improved, head control had improved, food intake had improved as swallowing and drolling of saliva had improved with overall increase in muscle strength.

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Treatment guidelines for tuberculosis and tuberculous meningitis

Cited by 4 publications

References 72 publications

Neutrophil-Mediated Immunopathology and Matrix Metalloproteinases in Central Nervous System – Tuberculosis

Neutrophil-Mediated Immunopathology and Matrix Metalloproteinases in Central Nervous System – Tuberculosis

Treatment outcomes and risk factors of death in childhood tuberculous meningitis in Kandahar, Afghanistan: a prospective observational cohort study

Effectiveness of preliminary physiotherapy intervention in a child with tubercular meningitis along with acute ischemic infarct

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