Tuberculous Meningitis in Children and Adults: A 10-Year Retrospective Comparative Analysis

Miftode, Egidia; Dorneanu, Olivia; Leca, Daniela; Juganariu, Gabriela; Teodor, Andra; Hurmuzache, Mihnea; Năstase, Eduard Vasile; Anton-Paduraru, Dana Teodora

doi:10.1371/journal.pone.0133477

Cited by 64 publications

(49 citation statements)

References 20 publications

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“…Among the extrapulmonary tuberculosis TB Meningitis has a higher incidence (Tanden et al 1970). [11] Onset: In the present study, the onset is acute in 28% and subacute in 32% and insidious in 40% in adults. (Udani PK 1970).…”

Section: Discussionsupporting

confidence: 46%

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A Study on Clinical Analysis of Central Nervous System Tuberculosis in Adults and Treatment Outcome

Narayanan¹,

Madhavan²,

Anandan³

2017

AIMDR

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Background: Tuberculosis of the central nervous system (CNS) is a highly devastating form of tuberculosis, which, even in the setting of appropriate antitubercular therapy, leads to unacceptable levels of morbidity and mortality. Aim: To study the various clinical presentations of Central Nervous System Tuberculosis, complication, morbidity and mortality and various types of treatment modalities and their outcome. Methods: 240 patients with CNS-TB were included in the study. Detail history of any prior antituberculous treatment, their duration, and regimen was enquired. A thorough general examination was made including pulse, blood pressure, skeletal system, skin, and eye. Nervous system was examined in detail looking for signs of meningeal irritation and focal neurological deficit. Results: 19 patients (63.3%) were tuberculous meningitis, 7 patients (28.3%) were tuberculoma of the brain, 2 patients (6.6%) were tuberculous Arachnoiditis, and 2 patients were Pott's paraplegia (6.6%). In TBM patients, who had presented as 'Aseptic Meningitis' form had food recovery without any sequelae. In this series, complete recovery was 66.6% mortality was 13.3% and sequelae in 20%. Patients treated with Pyrazinamide had its full effect during first 2 months of treatment and had a good recovery. Conclusion: Timely diagnosis of central nervous system tuberculosis is of key importance because delayed treatment is associated with higher morbidity and mortality.

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Section: Discussionsupporting

confidence: 46%

“…Tandon et al (1970) has the access rate varied from 5% to 15%. [11] CT scan was taken for all the patients. 8 patients had showed thick basilar exudates which appear as intensely enhancing area in the basal cistern.…”

Section: Discussionmentioning

confidence: 99%

A Study on Clinical Analysis of Central Nervous System Tuberculosis in Adults and Treatment Outcome

Narayanan¹,

Madhavan²,

Anandan³

2017

AIMDR

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“…Miftode et al reported TBM Grade II in 68% of patients. [8] Almost onethird of patients (33.3%) had active TB on chest X-ray. On cranial CT or MRI, 28.2% of patients had hydrocephalus, 7.6% tuberculoma, and 5.1% had spinal arachnoiditis presenting as paraparesis.…”

Section: Discussionmentioning

confidence: 99%

Cross sectional study of 39 Cases of Tuberculous Meningitis in North Bihar

Kumar¹,

Goswami²,

Singh³

et al. 2017

Int J Trop Med Public Health

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Background: Tuberculous meningitis (TBM) is the most severe manifestation of extrapulmonary tuberculosis (TB) with a high mortality and morbidity rates. Exact prevalence of central nervous system TB in India is not known, but it accounts for an estimated 1% of all cases of TB, which equates to around 17,000 cases in India in 2014. The aims of the study are: (1) To review the clinical, laboratory, disease staging, and radiological findings of 39 TBM cases at a single center and (2) to present the local epidemiological data from our cases.Methods: A total of 39 patients admitted to our tertiary hospital with symptoms and signs of meningitis were selected and on the basis of adopted criteria labeled as TBM. Clinical profile, disease staging, and cerebrospinal fluid (CSF) findings noted in each patient. Adenosine deaminase (ADA) level in CSF estimated. Cutoff value of ADA kept at or above 10 IU/L for TBM. The comparative study made with 23 patients of pyogenic meningitis. Results:The mean age of patients with tubercular meningitis was 39.07 ± 16.67 years. The symptom duration ranges from 7 to 98 days with a median of 28 days. Clinically, fever was present in 37 (94.8%), headache in 29 (74.3%), and vomiting in 22 (56.4%) patients. Six (15.38%) patients had seizure. On CSF cytological and biochemical analysis, the mean total white blood cell count was 256.74 ± 184.03/cmm, mean protein 182.22 ± 113.12 mg/dl, and mean sugar 52.85 ± 19.3 mg/dl. The CSF glucose:protein ratio in TBM was 0.41. Out of 39 TBM patients, 33 patients were found to be having CSF ADA at or above the cutoff value of 10 IU/L, whereas six had below cutoff value. On comparison between two groups, the CSF-ADA level found to be highly significant (P < 0.001). On cranial computed tomography or magnetic resource imaging, 28.2% of patients had hydrocephalous, 7.6% with tuberculoma, and 5.1% with spinal arachnoiditis. About one-third of patients had evidence of active TB on chest X-ray. Conclusions:Any patient presenting either acutely or chronically with signs and symptoms of meningitis, urgent CSF examination should be done to diagnose TBM on the basis of CSF lymphocytic pleocytosis, decreased glucose, increased protein, and ADA more than 10 IU/L. Due to high mortality and morbidity, early initiation of antitubercular drugs may prevent sequel.

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“…Most of TBM cases are diagnosed in advanced stages due to its vague presentation in the early phase (5), misinterpretation of disease by physicians, patient's low socioeconomic condition, and sometimes rapid progression of TBM (6).…”

Section: Introductionmentioning

confidence: 99%

Serial Polymorphonuclear Predominance of Cerebrospinal Fluid in a Child with Advanced Tuberculous Meningitis: A Case Report

Hosamirudsari

Afsari

Etesam

2017

Iran Red Crescent Med J

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Introduction: Tuberculous meningitis (TBM) is the most fatal form of tuberculosis. Despite adequate treatment, its mortality and morbidity is high. Clinical, laboratory, and radiologic findings help in diagnosis of TBM, although analysis of cerebrospinal fluid (CFS) might sometimes delay and mislead the rapid diagnosis. Case Presentation: We present a 14-year-old Afghan immigrant male, with uncommon laboratory results of advanced TBM, who referred to Baharloo hospial in Tehran, Iran, in September 2016. He experienced headache and anxiety one month prior to referring to the hospital; he had fever, severe headache, vomiting and showed bizarre behavior 7 days before admission. Suspecting meningoencephalitis, the physician advised empirical treatment. The first CSF revealed polymorphonuclear (PMN) predominance with low glucose, which was repeated in the second and third CSF analysis. This pattern indicates early phase of TB meningitis. In day 4, antituberculous treatment with corticosteroid was administered empirically. Unfortunately, he succumbed to disease in day 36. Polymerase chain reaction (PCR) for mycobacterium tuberculosis (MTB) in CSF was positive. The patient's presentation (lethargic to coma) and brain computed tomography (CT) scan indicated advanced stage of disease. Conclusions: All physicians should consider TB meningitis in any patient with low glucose even with serial PMN predominance in CSF.

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Tuberculous Meningitis in Children and Adults: A 10-Year Retrospective Comparative Analysis

Cited by 64 publications

References 20 publications

A Study on Clinical Analysis of Central Nervous System Tuberculosis in Adults and Treatment Outcome

A Study on Clinical Analysis of Central Nervous System Tuberculosis in Adults and Treatment Outcome

Cross sectional study of 39 Cases of Tuberculous Meningitis in North Bihar

Serial Polymorphonuclear Predominance of Cerebrospinal Fluid in a Child with Advanced Tuberculous Meningitis: A Case Report

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