Tuberculous meningitis – clinical and laboratory review of 100 patients

Kilpatrick, Michael E.; Girgis, Nabil I.; Yassin, Mohamed W.; Ella, Dalal A. Abou El

doi:10.1017/s0022172400066006

Cited by 40 publications

(20 citation statements)

References 36 publications

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“…The timing of the lumbar puncture was determined by the clinicians when they wanted to see the effect of treatment and not for experimental purposes alone. One patient (patient 8) was sampled five times, 2 patients (patients 5 and 22) were sampled four times, 4 patients (patients 1, 11, 18, and 20) were sampled three times, 8 patients (patients 2, 4, 6, 7, 12, 14, 15, and 24) were sampled twice, and 10 patients (patients 3,9,10,13,16,17,19,21,23, and 25) were sampled only once. The detailed sampling frequency and the time period from the time of disease onset to the sampling day for each patient are listed in Table 1.…”

Section: Methodsmentioning

confidence: 99%

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Comparative Evaluation of Early Diagnosis of Tuberculous Meningitis by Different Assays

et al. 2006

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Cerebrospinal fluid (CSF) and peripheral blood (PBL) were sampled multiple times from 25 patients with a clinical diagnosis of tuberculous meningitis (TBM) and 49 controls, including 27 patients with other infectious diseases of the central nervous system and 22 patients with other noninfectious neurological diseases. We used an enzyme-linked immunospot assay (ELISPOT) to detect anti-Mycobacterium bovis BCG antibody-secreting cells in CSF and PBL, PCR to detect a repeated insertion sequence (IS6110) specific for Mycobacterium tuberculosis in CSF, and an enzyme-linked immunosorbent assay (ELISA) to detect anti-BCG antibodies in CSF and PBL. In the meantime, culture of CSF from every TBM and control patient was done on Lowenstein-Jensen medium. ELISPOT proved to be the most valuable test, with a sensitivity of 84.0% and a specificity of 91.8%, and showed a sensitivity of 100.0% with the CSF specimens obtained within 4 weeks after the onset of TBM. The numbers of CSF anti-BCG immunoglobulin-secreting cells tested by ELISPOT were even higher in the early phase of TBM and declined while the disease was going on (P ‫؍‬ 0.008), which allowed an early diagnosis to be made. The sensitivities of PCR and ELISA were only 75.0% and 52.3%, respectively; and the specificities were 93.7% and 91.6%, respectively. Culture of CSF on Lowenstein-Jensen medium was the least sensitive (16%) compared to the sensitivities of the other three assays. Our results demonstrate that the ELISPOT technique is worthy for routine use in the laboratory to support the clinical diagnosis of TBM.In the past several years there has been a global increase in the incidence of tuberculosis along with the prevalence of AIDS and the emergence of multidrug-resistant strains. Tuberculous meningitis (TBM) is a major global health problem and is the most severe form of extrapulmonary tuberculosis, with a high rate mortality. TBM is diagnosed on the basis of clinical features, cerebrospinal fluid (CSF) studies, and radiological findings. Due to the variable clinical presentations and CSF findings, which can be confused with those of other chronic infections of the central nervous system (CNS), TBM is sometimes difficult to diagnosis with certainty, especially in its early phase (about 1 to 2 weeks after onset, according to our clinical observations). During this time period, the typical clinical manifestations of TBM have not fully developed. The polymorphonuclear pleocytosis in CSF can occur early and may give an erroneous impression of bacterial meningitis. Also during this time period, the antibiotic or antituberculous treatment has lasted for just a short time, and the effect of therapy is not obvious enough to be able to make a judgment. The contrast enhancement of the basal cisterns, hydrocephalus, or lesions in the brain parenchyma on a computed tomography (CT) image or a magnetic resonance imaging image specific for TBM may not occur so early. Previous clinical studies have clearly demonstrated that the timing of the onset of chemotherapy is the most cr...

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Section: Methodsmentioning

confidence: 99%

“…The laboratory confirmation of TBM depends on the demonstration of Mycobacterium tuberculosis in CSF by culture or smear. However, smears for acid-fast bacilli exhibited a few positive results (22), with a sensitivity of about 10% (13). Culture on Lowenstein-Jensen medium takes about 8 weeks and has a limited sensitivity of about 15% (1,19,23).…”

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Comparative Evaluation of Early Diagnosis of Tuberculous Meningitis by Different Assays

et al. 2006

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“…In a recent case series from the United States, 17% of patients with tuberculous meningitis (TBM) died during the first 9 months of therapy [1•]. In countries with a high incidence of tuberculosis, the mortality rate may be greater than 50% [2], and survivors may be left with significant neurologic disabilities. In this review, we discuss the influence of HIV infection on the pathogenesis and clinical course of TBM, and review therapeutic considerations for the HIV-infected individual with TBM.…”

Section: Introductionmentioning

confidence: 99%

Tuberculous meningitis in HIV-infected individuals

Vinnard

MacGregor²

2009

Curr HIV/AIDS Rep

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HIV-infected individuals are at increased risk for all forms of extrapulmonary tuberculosis, including tuberculous meningitis. This risk is increased at more advanced levels of immunosuppression. The time interval between onset of symptoms and presentation to medical care may vary widely, and consequently individuals may present with acute or chronic meningitis. The clinical presentation of tuberculous meningitis in HIV-infected individuals is more likely to include an altered level of consciousness, cranial imaging is more likely to show cerebral infarctions, and the yield of culture of cerebrospinal fluid may also be greater. Given that delayed initiation of therapy is a strong predictor of mortality in cases of tuberculous meningitis, clinicians must consider tuberculosis in the differential diagnosis of the HIV-infected individual with acute or chronic lymphocytic meningitis. Additional treatment considerations for HIV-infected individuals include the timing of initiation of antiretroviral therapy, the potential for drug–drug interactions, and the role of adjunctive corticosteroid therapy.

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“…Among tubercular infections, tuberculous meningitis (TBM) leads to multiple central nervous system (CNS) complications and remains a major health problem in underdeveloped and developing countries (1,9,16). Even in developed countries where a decade ago it was rare, it has reappeared following human immunodeficiency virus infection (6,14,29).…”

mentioning

confidence: 99%

Demonstration of Components of Antigen 85 Complex in Cerebrospinal Fluid of Tuberculous Meningitis Patients

Kashyap

Dobos

Belisle

et al. 2005

Clin Vaccine Immunol

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Tuberculosis is the leading cause of death among communicable diseases, killing nearly 2 million people each year (2, 13). Among tubercular infections, tuberculous meningitis (TBM) leads to multiple central nervous system (CNS) complications and remains a major health problem in underdeveloped and developing countries (1, 9, 16). Even in developed countries where a decade ago it was rare, it has reappeared following human immunodeficiency virus infection (6, 14, 29). Early and rapid confirmatory diagnosis is still difficult due to the clinical picture of TBM and similarities of TBM cerebrospinal fluid (CSF) to that of partially treated pyogenic meningitis, which results in frequent diagnostic confusion (4,21,28,33). Early and reliable diagnosis of TBM still poses a great challenge. In most of the cases, diagnosis relies on clinical observations, imaging of the infected area, and detection of Mycobacterium tuberculosis in CSF by acid-fast bacillus (AFB) staining and culturing. A number of immunological and molecular methods have been reported, but these cannot be employed in standard pathology laboratories and are often not useful for early confirmative diagnosis of TBM (3,7,11,15,22,23,25,26,31,35).To overcome the deficiencies in TBM diagnosis, we set forth to identify specific protein markers unique to CSF samples collected from suspected patients with TBM. By analyzing the total sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) protein profile of such CSF, we observed a 30-kDa protein band specific to these patients (18). Further, all 30-kDa protein-positive CSF samples tested with polyvalent antibodies against culture filtrate proteins (CFP) of M. tuberculosis strain H 37 Rv by the single radial immunodiffusion (SRID) method indicated that the CSF of TBM patients possesses M. tuberculosis antigens (17).These early investigations led us to hypothesize that molecular identification of the TBM-specific 30-kDa CSF protein would allow for development of specific reagents and protocols for the rapid and accurate diagnosis of TBM. In this report, the application of two-dimensional polyacrylamide gel electrophoresis (2D-PAGE) and liquid chromatography tandem mass spectrometry (LC-MS/MS) identified two mycobacterial proteins of the antigen 85 (Ag85) complex (Rv3804c and Rv1886c) and one host-derived protein (immunoglobulin [Ig] kappa light * Corresponding author. Mailing address:

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Tuberculous meningitis – clinical and laboratory review of 100 patients

Cited by 40 publications

References 36 publications

Comparative Evaluation of Early Diagnosis of Tuberculous Meningitis by Different Assays

Comparative Evaluation of Early Diagnosis of Tuberculous Meningitis by Different Assays

Tuberculous meningitis in HIV-infected individuals

Demonstration of Components of Antigen 85 Complex in Cerebrospinal Fluid of Tuberculous Meningitis Patients

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