Tuberculous meningitis in an urban general hospital

Haas, Erwin J.; Madhavan, T.; Quinn, Edward; Cox, F. M. E.; Fisher, Evelyn; Burch, Keith H.

doi:10.1001/archinte.137.11.1518

Cited by 27 publications

(5 citation statements)

References 7 publications

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“…Other studies reported moderate to severe neurological sequelae in 25-50% children treated with isoniazide [1,2]. In adults, percentage of neurological handicaps varies from 0% to 56.1% of survivors [5][6][7]15,21,22]. In our study, mild to severe neurological sequelae were noted in about 78.5% patients although 50% of patients were independent for activities of daily living.…”

Section: Discussioncontrasting

confidence: 39%

Predictors of long‐term neurological sequelae of tuberculous meningitis: a multivariate analysis

Kalita,

Misra,

Ranjan

2007

Euro J of Neurology

137

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There is paucity of studies on predictors of long-term sequelae of tuberculous meningitis (TBM). We report the neurological sequelae of TBM at 1 year and their predictors. Patients with TBM who were followed up for 1 year were included. The diagnosis of TBM was based on clinical, cerebrospinal fluid (CSF) and computed tomography (CT) scan findings. Detailed neurological examinations at admission and at 1 year were carried out. All the patients received four-drug antitubercular therapy. The frequency of sequelae at 1 year were noted and the role of various demographic (age, sex, duration of illness, BCG vaccination), clinical (weakness, seizure, extra central nervous system tuberculosis, Glasgow Coma Scale (GCS) score, cranial nerve palsy, stage, corticosteroid, drug-induced hepatitis, shunt surgery), and laboratory findings (erythrocyte sedimentation rate (ESR), CSF cell and protein, CT scan evidences of hydrocephalus, basal exudates, infarctions and tuberculoma) at presentation were evaluated employing logistic regression analysis. Sixty-five patients with TBM were included in this study whose age ranged between 13 and 80 years (mean 33.2), 27 of whom were females. Complete neurological recovery at 1 year occurred in 21.5% patients only although about 50% were independent for activities of daily living. Neurological sequelae were observed in 78.5% patients, which included cognitive impairment in 55%, motor deficit in 40%, optic atrophy in 37% and other cranial nerve palsy in 23%. On logistic regression analysis, focal motor deficit at admission was the most important predictor of neurologic deficits at 1 year. GCS score predicted the cognitive and motor sequelae. Neurological sequelae at year occurred in 78.5% patients with TBM in the form of cognitive impairment, motor deficit and optic atrophy. Sequelae were common in patients who had focal motor deficit and altered sensorium at admission.

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Section: Discussioncontrasting

confidence: 39%

Predictors of long‐term neurological sequelae of tuberculous meningitis: a multivariate analysis

Kalita,

Misra,

Ranjan

2007

Euro J of Neurology

137

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“…In the elderly, as in younger patients, the illness is subacute, usually with headache rather than meningismus. In some cases, nonspecific symptoms such as anorexia and fatigue may direct at tention away from the central nervous system [14,19]. The diagnosis should be considered in any elderly patient with obtundation or dementia of recent onset whose cerebrospinal fluid shows hypoglycorrhachia, a lympho cytic pleocytosis, and no growth on routine bacterial and fungal cultures [3],…”

Section: Tuberculous Meningitis Tuberculous Meningitis In the Unitedmentioning

confidence: 99%

Aging and Tuberculosis

Nagami¹,

Yoshikawa²

1984

Gerontology

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In the United States, an increasing proportion of all forms of reactivation tuberculosis occurs in patients over the age of 60 years. Atypical presentations and presence of chronic illness obscure the diagnosis of tuberculosis in the elderly. Prompt diagnosis requires a high index of suspicion and aggressive procedures for diagnostic microbiology. Short-course (9 months) chemotherapy with isoniazid and rifampin is the treatment of choice for elderly patients with uncomplicated pulmonary tuberculosis. Isoniazid chemoprophylaxis is recommended for selected elderly patients.

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“…9 Workers from tropic countries, attain bacteriological proof in only 10-20% of cases. 10 Levels of ADA in CSF are known to be increased in TBM.…”

Section: Introductionmentioning

confidence: 99%

Adenosine deaminase activity in cerebrospinal fluid: diagnostic investigation in central nervous system disorders in children

Rahaman

Panda

Mandal

et al. 2017

Int J Contemp Pediatr

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Background: Tubercular meningitis (TBM) is an endemic disease in developing countries. Adenosine deaminase activity (ADA) has been of great importance for many years in TBM diagnosis. The objective of this study was to determine the CSF-ADA levels in different CNS disorders, to compare the CSF-ADA activity in different types of meningitis, to find out the sensitivity and specificity of CSF-ADA in the diagnosis of TBM and to establish the prognostic value of CSF-ADA in TBM in comparison to Control group.Methods: For control group CSF was collected from the patients of simple febrile convulsions and idiopathic epilepsy.Results: The present study was carried out in the 112 cases of different CNS disorders, age ranging from 4 months to 12 years with a mean age of 4.12 years and 38 cases (27+11) of control group (simple febrile convulsion and idiopathic epilepsy). In the present study CSF-ADA level was statistically significantly increased in all types of meningitis (p<0.05). In case of TBM, the mean CSF-ADA level increased statistically significantly with increase in CSF protein level (p<0.05). In case of TBM, there was no significant difference in the mean ADA value according to CSF sugar level (p<0.10). In case of TBM, the mean CSF-ADA level increased significantly with increase in CSF cell count (p< 0.01) mainly lymphocytes.Conclusions: Thus it can be concluded from our study that CSF-ADA estimation is relatively simple and inexpensive procedure in the early diagnosis of tuberculous meningitis with high sensitivity (100%) and specificity (97.5%) at a cut-off level of 5IU/L and can be used in differentiating TBM from other types of meningitis. Along with diagnostic utility of CSF-ADA, it has also prognostic value in the follow-up case of tuberculous meningitis.

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Tuberculous meningitis in an urban general hospital

Cited by 27 publications

References 7 publications

Predictors of long‐term neurological sequelae of tuberculous meningitis: a multivariate analysis

Predictors of long‐term neurological sequelae of tuberculous meningitis: a multivariate analysis

Aging and Tuberculosis

Adenosine deaminase activity in cerebrospinal fluid: diagnostic investigation in central nervous system disorders in children

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