Tuberculous meningitis diagnosis and treatment in adults: A series of 189 suspected cases

Luo, Mingyao; Wang, Weifei; Zeng, Qingbei; Luo, Yue‐Bei; Yang, Huan; Yang, Xinming

doi:10.3892/etm.2018.6496

Cited by 23 publications

(28 citation statements)

References 18 publications

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“…Meningeal tuberculosis is one of the most difficult causes of meningitis to diagnose due to the difficulties in identifying mycobacteria, which is why any patient with any symptoms and signs of meningitis should be considered TB infected in regions with a high prevalence or in population of high risk. It is important to state that Mexico has the third place of TB prevalence after Brazil and Peru (WHO 2019), TBM is an infectious disease with high rates of disability and mortality (12), worldwide the prevalence of disseminated disease vary between 30-50% of infected patients (WHO 2019) while in the current report, our series showed 25% of active lung TB.…”

Section: Discussionmentioning

confidence: 51%

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Tuberculous meningitis in adult patients of a Mexican neurological referral center: A-six-year retrospective cohort study

Maldonado-Díaz¹,

Soto-Hernández²,

Salinas-Lara³

et al. 2020

Preprint

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IntroductionTuberculosis (TB) remains as an important concern of public health worldwide because the high prevalence and severe sequelae. Tuberculous meningitis (TBM) is the most lethal and disabling form.AimTo describe the clinical, laboratory, and neuroimaging characteristics of TBM on admission at neurological center in Mexico City.MethodsRetrospective cohort study at the third level neurological center from 2010 to 2016. Clinical follow-up was evaluated at hospital discharge, three months, and one-year either due to lack of follow-up or mortality, during the follow-up the adverse events were registered.ResultsOne-hundred and six patients were included, 74 (69.8%) males and 32 (30.2%) females. From these 31 (29.2%) were HIV-positive. The median age was 35.5 (IQR:28-51). Pulmonary TB was found in 25% of the population. Alcoholism was observed in a half of the patients while diabetes in 15%, the latter being significant (p=0.04). Abnormalities in neuroimaging were significant among our population (p=0.003). Only one-third of the population had a positive Lowenstein-Jensen culture. There were no differences in clinical outcomes between HIV positive and non-HIV patients.ConclusionOur study shows data to those described in the literature. The initiation of empirical treatment in all patients with a high clinical suspicion of tuberculosis mandatory to try to avoid severe neurological sequels.

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Section: Discussionmentioning

confidence: 51%

“…Median glycorrhachia was 47 mg/dL (ranges 18-64), proteinorachia 95 mg/dL (44-188) and cellularity 53.5 cells/mm 3 . Th median CSF adenosine deaminase level was 7 UI/L (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). No differences were observed between groups.…”

Section: Csf Cytochemical and Laboratory Findingsmentioning

confidence: 96%

Tuberculous meningitis in adult patients of a Mexican neurological referral center: A-six-year retrospective cohort study

Maldonado-Díaz¹,

Soto-Hernández²,

Salinas-Lara³

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…The traditional treatment for pulmonary TB has been standardized to the RIPE [rifampin (RIF), isoniazid (INH), pyrazinamide, ethambutol) therapy for 2 months followed by RI (rifampin, isoniazid) for 10 months [ 20 , 23 , 37 , 38 , 39 ]. The empirical treatment for TBM remains the same as the treatment for pulmonary TB; the empirical treatment is warranted when clinical features and CSF findings are suggestive of TBM, even before microbiologic confirmation, since timely treatment dramatically improves the outcome of TBM [ 20 , 23 ].…”

Section: Resultsmentioning

confidence: 99%

“…It is worth mentioning that patients who present with TB with past medical history conditions are not treated similarly. For example, HIV patients are given the standard regimen of 2 months RIPE followed by 10 months of RI, but also given an ART therapy after [ 20 , 23 , 37 , 38 , 39 ]. Patients who develop syndrome of inappropriate antidiuretic hormone (SIADH) from M. tuberculosis infection should engage in fluid restriction and take medications such as furosemide and demeclocycline.…”

Section: Resultsmentioning

confidence: 99%

Analysis of Tuberculosis Meningitis Pathogenesis, Diagnosis, and Treatment

Arshad

Dayal

Gadhe

et al. 2020

JCM

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Tuberculosis (TB) is the most prevalent infectious disease in the world. In recent years there has been a significant increase in the incidence of TB due to the emergence of multidrug resistant strains of Mycobacterium tuberculosis (M. tuberculosis) and the increased numbers of highly susceptible immuno-compromised individuals. Central nervous system TB, includes TB meningitis (TBM-the most common presentation), intracranial tuberculomas, and spinal tuberculous arachnoiditis. Individuals with TBM have an initial phase of malaise, headache, fever, or personality change, followed by protracted headache, stroke, meningismus, vomiting, confusion, and focal neurologic findings in two to three weeks. If untreated, mental status deteriorates into stupor or coma. Delay in the treatment of TBM results in, either death or substantial neurological morbidity. This review provides latest developments in the biomedical research on TB meningitis mainly in the areas of host immune responses, pathogenesis, diagnosis, and treatment of this disease.

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“…The purified protein derivative (PPD) skin test, MycoDot test [4] and interferon-gamma release assay yielded positive results. Cerebral examination showed increased intracranial pressure, elevated cerebrospinal fluid (CSF) protein concentration, and decreased CSF glucose and chloride, suggesting the diagnosis of tuberculous meningitis [5]. Ocular fundus photography showed macular oedema, stellate exudation and an absent foveal reflex in the right eye (Fig.…”

Section: Case Presentationmentioning

confidence: 99%

Concurrent tuberculous chorioretinitis with choroidal neovascularization and tuberculous meningitis: a case report

Zhang

Gao

et al. 2020

BMC Ophthalmol

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Background: Tuberculosis (TB) remains a severe health burden worldwide. The manifestation of concurrent tuberculous cerebral and ocular involvements associated with TB is uncommon. Case presentation: We report a 17-year-old girl with concurrent tuberculous cerebral and ocular involvements and visual impairment due to choroidal neovascularization. This study emphasizes the definite diagnosis with the combination of ophthalmological examination, multimodal imaging and routine tuberculosis testing, and the proper management with intravitreal anti-VEGF injection accompanied by systemic anti-tuberculosis therapy. Conclusion: Combined applications of routine TB tests, fundus multimodal imaging and diagnostic therapy greatly help the clinician to establish a precise diagnosis and in monitoring the therapeutic response.

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Tuberculous meningitis diagnosis and treatment in adults: A series of 189 suspected cases

Cited by 23 publications

References 18 publications

Tuberculous meningitis in adult patients of a Mexican neurological referral center: A-six-year retrospective cohort study

Tuberculous meningitis in adult patients of a Mexican neurological referral center: A-six-year retrospective cohort study

Analysis of Tuberculosis Meningitis Pathogenesis, Diagnosis, and Treatment

Concurrent tuberculous chorioretinitis with choroidal neovascularization and tuberculous meningitis: a case report

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