266 results on '"CNS tuberculosis"'
Search Results
2. Bilateral vocal cord palsy as complication of CNS tuberculosis
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Liesa Regner-Nelke, Bendix Labeit, Christopher Nelke, Wolfram Schwindt, Rainer Dziewas, and Sonja Suntrup-Krueger
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Bilateral vocal cord palsy ,Tuberculous meningitis ,CNS tuberculosis ,Cranial nerves ,Case report ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Abstract Background Tuberculous meningitis, a rare but severe form of extrapulmonary tuberculosis, frequently affects cranial nerves. While nerves III, VI and VII are commonly involved, involvement of caudal cranial nerves is rarely described. Here, we report a rare case of bilateral vocal cord palsy secondary to caudal cranial nerve involvement in tuberculous meningoencephalitis, that occurred in Germany, a country with low tuberculosis incidence. Case presentation A 71-year-old woman was transferred for further treatment of hydrocephalus as a complication of presumed bacterial meningitis with unknown pathogen at that time. Because of decreased consciousness, intubation was performed and an empiric antibiotic therapy with ampicillin, ceftriaxone and acyclovir was initiated. Upon admission to our hospital, an external ventricular drainage was placed. Cerebrospinal fluid analysis revealed Mycobacterium tuberculosis as the causative pathogen, and antitubercular treatment was initiated. Extubation was possible one week after admission. Eleven days later, the patient developed inspiratory stridor that worsened within a few hours. Flexible endoscopic evaluation of swallowing (FEES) revealed new-onset bilateral vocal cord palsy as the cause of respiratory distress, which required re-intubation and tracheostomy. The bilateral vocal cord palsy persisted despite continued antitubercular therapy on the follow-up examination. Conclusion Considering the aetiology of infectious meningitis, cranial nerve palsies may be suggestive for tuberculous meningitis as underlying disease given their rarity in other bacterial forms of meningitis. Nevertheless, intracranial involvement of inferior cranial nerves is rare even in this specific entity, as only extracranial lesions of inferior cranial nerves have been reported in tuberculosis. With this report of a rare case of bilateral vocal cord palsy due to intracranial involvement of the vagal nerves, we emphasize the importance of timely initiation of treatment for tuberculous meningitis. This may help to prevent serious complications and associated poor outcome since the response to anti-tuberculosis therapy may be limited.
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- 2023
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3. Clinical, Laboratory and Radiological Correlates of Xpert MTB/RIF Assay Study in Cerebrospinal Fluid in CNS Tuberculosis.
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R., Pratheesh Anand, Tandon, Ruchika, and Jha, Sanjeev
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EXTRAPULMONARY tuberculosis , *CENTRAL nervous system , *LOSS of consciousness , *TUBERCULOSIS patients , *CEREBROSPINAL fluid - Abstract
Background: Cerebrospinal fluid (CSF) Xpert MTB/RIF assay is an initial test for the diagnosis of tuberculous meningitis (TBM). Nevertheless, it is not very clear which of the factors govern CSF-Gene Xpert/MTB positivity. Objective: Hence, we aimed to assess the relationship, if any, between the clinical, laboratory and radiological parameters of the central nervous system (CNS) tuberculosis patients and the Gene Xpert study in CSF in such patients. Methods and Material: First, we studied 200 patients with CNS tuberculosis according to the case definition, and subsequently, we performed a Gene Xpert study on the CSF of these patients. Then, we correlated the clinical, radiological, and CSF criteria with the Gene Xpert positivity using the univariate binary logistic regression method via SPSS 20 (P-value <0.05). Results: Seventy-five (37.5%) patients (57.3% females) of median 24 years of age, were CSF-Gene Xpert/MTB-positive and 125 (62.5%) patients were negative. The mean duration of illness (P = 0.017), weight loss or failure to thrive (P < 0.001), loss of consciousness or seizure (P = 0.001), signs of meningeal irritation (P = 0.027), stage III of TBM (P < 0.001), evidence of dissemination (P = 0.003), basal exudates (P = 0.004), hydrocephalus (P = 0.018), CSF lymphocytic predominance (P < 0.001), and reduced CSF glucose (P = 0.011) correlated significantly with positive the Gene Xpert/MTB results. Also, Gene Xpert had a sensitivity of 80% and a specificity of 74.84% against culture Xpert. Conclusions Xpert MTB/RIF might be more useful in the later stages of the disease and those with more severe disease. [ABSTRACT FROM AUTHOR]
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- 2024
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4. Pontine tubercular abscess: A rare presentation of CNS tuberculosis masquerading as glioma in a child.
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Adhikari, Bikash Chandra, Rouniyar, Sangam, Roy, Ujjawal, Kunwor, Bishal, and Lama, Ashmina
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GLIOMAS , *ABSCESSES , *TUBERCULOSIS , *TUBERCULOUS meningitis , *BRAIN abscess , *MEDICAL drainage - Abstract
Key Clinical Message: Tuberculous brain abscess (TBA) in a child was initially misdiagnosed as glioma. Two craniotomies, abscess drainage, and anti‐tubercular therapy led to recovery. Pontine TBA, though rare and atypical, can have better outcome with timely intervention. [ABSTRACT FROM AUTHOR]
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- 2024
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5. The role of TNF receptors as mediators of chronic vasculitis in possible milder forms of the CNS tuberculosis.
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Rivas-Castro, Alejandro, Salinas-Lara, Citlaltepetl, Garibay, Carlos Sánchez, Abarca-Rojano, Edgar, Hernández-Pando, Rogelio, Marquina-Castillo, Brenda, Barrada, Manuel Alejandro Flores, Díaz, Yazmín Peralta, León-Marroquín, Elsa Yazmín, Suck, Martha Lilia Tena, Mendoza, Jessica Medina, Gama, Yaser Sánchez, Rojas, Luis O. Soto, Parra, José Alberto Choreño, and Romero-López, José Pablo
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TUMOR necrosis factor receptors , *TUBERCULOUS meningitis , *TUBERCULOSIS , *TUMOR necrosis factors , *VASCULITIS , *CENTRAL nervous system - Abstract
Introduction: Central nervous system (CNS) tuberculosis (TB) is the most severe form of TB due to its high mortality and functional sequelae. There are several differential diagnoses for TB; and, it can also cause secondary conditions, such as vasculitis. Methodology: 155 biopsies, corresponding to 155 different patients out of 5,386 registered biopsies from 2008-2013, met the criteria of unknown etiology vasculitis and evidence of cerebral vascular disease. These were analyzed to assess the presence of central nervous system TB. The selected cases were assessed with Suzaan Marais (SM) criteria for clinical tuberculosis. After that, Ziehl-Neelsen (ZN) staining and polymerase chain reaction (PCR) were performed to amplify a fragment of the insertion sequence IS6110 of M. tuberculosis. 21 patients met the criteria for definitive tuberculosis by ZN staining and PCR, and 2 met the criteria for possible tuberculosis. Tumor necrosis factor (TNF)- α, TNF-R1, and TNF-R2 were determined by immunohistochemistry in histological sections from formalin-fixed paraffin-embedded (FF-PE) tissues in the 23 selected patients. Results: Granulomatous TB was present in almost half of the cases. TNF-R1 and TNF-R2 were expressed mainly in blood vessels, histiocytes, and macrophages. TNF-R2 expression was higher than the other markers, which suggests an anti-inflammatory response against M. tuberculosis Conclusions: The histopathological presentation of TB is not always limited to granulomas, abscesses, or meningitis; there are also clinical presentations characterized only with chronic inflammation of nervous and vascular tissue. [ABSTRACT FROM AUTHOR]
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- 2023
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6. High-Resolution Vessel Wall MRI as a Complementary Investigation for CNS Tuberculosis
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Vinicius de Menezes Jarry, Laisson de Moura Feitoza, Marcelo de Carvalho Ramos, and Fabiano Reis
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Pathology ,medicine.medical_specialty ,business.industry ,High resolution ,General Medicine ,Tuberculosis, Central Nervous System ,medicine.disease ,Magnetic Resonance Imaging ,Tuberculous meningitis ,Neurology ,Tuberculosis, Meningeal ,CNS TUBERCULOSIS ,Humans ,Medicine ,Neurology (clinical) ,business - Published
- 2020
7. Central Nervous System Tuberculosis: Pathogenesis, Diagnosis, and Management
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Braley, Alexander E., Hall, Walter A., and Rezaei, Nima, Editor-in-Chief
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- 2023
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8. A true challenge: Disseminated tuberculosis with tuberculous meningitis in a patient with underlying chronic liver disease
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Harika Kalangi, Laura Rivera Boadla, David C. Perlman, Stanley R. Yancovitz, Vani George, and Nadim Salomon
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CNS Tuberculosis ,Chronic Liver Disease ,Anti-Tuberculosis Therapy ,Hepatotoxicity ,Tuberculous Meningitis ,Infectious and parasitic diseases ,RC109-216 - Abstract
Tuberculous meningitis (TBM) is a potentially life-threatening form of tuberculosis (TB) that affects the central nervous system. Its management in patients with concomitant chronic liver disease (CLD) presents unique challenges due to altered drug metabolism with potentially impaired spinal fluid drug penetration and hepatotoxicity. The standard regimen for TBM includes isoniazid (INH) and rifampin (RIF), and Pyrazinamide (PZA) which are metabolized by the liver and may cause hepatotoxicity, which can exacerbate preexisting liver disease. Thus, careful consideration is required to balance therapeutic efficacy with potential drug-induced hepatotoxicity. Regular monitoring of liver function tests and clinical response is essential to minimize adverse effects and optimize treatment outcomes. Further research is needed to establish evidence-based guidelines for the tailored management of TBM in this vulnerable patient subset. Overall, the treatment of TBM in patients with severe liver disease should be individualized and closely monitored.
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- 2024
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9. CNS Tuberculosis and Other Mycobacterial Infections
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Juan Carlos Garcia-Monco and Aida Rodriguez-Sainz
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Pathology ,medicine.medical_specialty ,Tuberculosis ,biology ,business.industry ,Lymphocytic pleocytosis ,biology.organism_classification ,medicine.disease ,Tuberculous meningitis ,Hydrocephalus ,Mycobacterium tuberculosis ,Basal (phylogenetics) ,Cerebrospinal fluid ,Immunology ,medicine ,Tuberculoma ,business - Abstract
Tuberculous meningitis is the most severe form of tuberculous infection (Mycobacterium tuberculosis) and presents as a subacute syndrome with lymphocytic pleocytosis and low glucose in the cerebrospinal fluid (CSF) and meningeal enhancement of the basal cisterns and hydrocephalus on neuroimaging.
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- 2017
10. Rapid diagnosis of CNS tuberculosis by a T-cell interferon-g release assay on cerebrospinal fluid mononuclear cells
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K. Kösters, Martin Ernst, I. Greiffendorf, Aik Bossink, Timothy S. C. Hinks, Ajit Lalvani, Steven F. T. Thijsen, R. Nau, M. Jentsch, and Christoph Lange
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Microbiology (medical) ,Adult ,Male ,Pulmonary and Respiratory Medicine ,Pathology ,medicine.medical_specialty ,Tuberculosis ,Time Factors ,T-Lymphocytes ,T cell ,Interferon gamma release assay ,Peripheral blood mononuclear cell ,Tuberculous meningitis ,Mycobacterium tuberculosis ,Interferon-gamma ,Cerebrospinal fluid ,Interferon ,medicine ,Humans ,Interferon gamma ,Cerebrospinal Fluid ,biology ,Latent tuberculosis ,business.industry ,ELISPOT ,General Medicine ,Tuberculosis, Central Nervous System ,medicine.disease ,biology.organism_classification ,Infectious Diseases ,medicine.anatomical_structure ,Tuberculoma, Intracranial ,Tuberculosis, Meningeal ,Immunology ,CNS TUBERCULOSIS ,business ,medicine.drug - Abstract
Central nervous system tuberculosis remains a clinical diagnostic challenge. The ex vivo Mycobacterium tuberculosis-specific enzyme-linked immunospot assay (ELISPOT) is a novel assay for the rapid detection of M. tuberculosis-specific T-lymphocytes in the peripheral blood. However, when performed on peripheral blood, this assay cannot distinguish between active tuberculosis or latent tuberculosis infection. On the assumption that M. tuberculosis-specific T-lymphocytes migrate to sites of infection, we were able to demonstrate high levels of M. tuberculosis-specific cells by ELISPOT in the cerebrospinal fluid of a patient with tuberculous meningitis and intracerebral tuberculoma four weeks before cerebrospinal fluid culture became positive for M. tuberculosis by culture.
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- 2008
11. Modulation of angiogenic factor VEGF by DNA-hsp65 vaccination in a murine CNS tuberculosis model
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Osvaldo Massaiti Takayanagui, Adriana Pelegrini-da-Silva, Fabiola C. R. Zucchi, Célio Lopes Silva, Ana Maria C. Tsanaclis, Quintino Moura-Dias, and Luciano Neder
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Male ,Vascular Endothelial Growth Factor A ,Microbiology (medical) ,Tuberculosis ,Angiogenesis ,Immunology ,Vascular permeability ,Microbiology ,Tuberculous meningitis ,Mice ,chemistry.chemical_compound ,Bacterial Proteins ,Antigen ,Cerebellar Diseases ,Cerebellum ,MODELOS ANIMAIS DE DOENÇAS ,Vaccines, DNA ,Animals ,Medicine ,Tuberculosis Vaccines ,Immunization Schedule ,Mycobacterium bovis ,biology ,business.industry ,Chaperonin 60 ,Tuberculosis, Central Nervous System ,biology.organism_classification ,medicine.disease ,Vaccination ,Vascular endothelial growth factor ,Disease Models, Animal ,Infectious Diseases ,Tuberculoma, Intracranial ,chemistry ,Tuberculosis, Meningeal ,business - Abstract
summary Tuberculosis (TB) is a serious public health problem. Development of experimental models and vaccines are essential to elucidate physiopathological mechanisms and to control the disease. Vascular endothelial growth factor (VEGF) is a potent activator of vascular permeability and angiogenesis. VEGF seems to participate in breakdown of the blood brain-barrier (BBB) in tuberculous meningitis (TBM), contributing to worsening of disease. Therefore, the objective here was to extent the characterization of our previously described murine model of central nervous system TB (CNS-TB) by describing the VEGF participation in the CNS disease, and suggesting a vaccination plan in mice. Plasmid encoding DNA protein antigen DNAhsp65 has been described as a protector against TB infection and was used here to test its effectiveness in the prevention of VEGF production and TB disease. Vaccinated mice and its controls were injected with Mycobacterium bovis bacillus Calmette-Guerin (BCG) in cerebellum. Four weeks after BCG injection, mice were perfused and brains were paraffin-embedded for VEGF expression analysis. We observed VEGF immunohistochemical expression in TBM and granulomas in non-vaccinated mice. The DNA-hsp65 treatment blocked the expression of VEGF in mice TBM. Therefore, our murine model indicated the VEGF participation in the physiopathology of CNS-TB and the potential prevention of the DNA-hsp65 in the disease progression.
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- 2013
12. CNS Tuberculosis and Other Mycobacterial Infections
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García-Moncó, Juan Carlos, Rodriguez-Sainz, Aida, and García-Moncó, Juan Carlos, editor
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- 2018
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13. Chronic Infectious Inflammatory Diseases of the Central Nervous System
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Taba, Pille, Lutsar, Irja, Deisenhammer, Florian, editor, Sellebjerg, Finn, editor, Teunissen, Charlotte E, editor, and Tumani, Hayrettin, editor
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- 2015
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14. CNS Tuberculosis and Other Mycobacterial Infections
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García-Moncó, Juan Carlos, Rodriguez-Sainz, Aida, and García-Moncó, Juan Carlos, editor
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- 2014
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15. Characteristics of cerebrospinal fluid under tuberculosis in patients with HIV-infection
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S. A. Panteleeva, A. V. Zonova, O. S. Sokolova, A. M. Panteleev, and A. V. Lutsenko
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030222 orthopedics ,medicine.medical_specialty ,Tuberculosis ,business.industry ,medicine.medical_treatment ,Immunology ,Central nervous system ,Public Health, Environmental and Occupational Health ,Immunosuppression ,medicine.disease ,Gastroenterology ,Tuberculous meningitis ,03 medical and health sciences ,0302 clinical medicine ,Infectious Diseases ,Cerebrospinal fluid ,medicine.anatomical_structure ,Internal medicine ,CNS TUBERCULOSIS ,medicine ,In patient ,030212 general & internal medicine ,Pleocytosis ,business - Abstract
Purpose. To carry out an analysis of characteristics and to reveal the peculiarities of laboratory changes of cerebrospinal fluid (CSF) in patients with tuberculosis of central nervous system associated with HIV-infection.Materials and methods. Analysis of 206 patients with CNS tuberculosis associated with HIV-infection who were treated in State Budgetary Healthcare Institution «City tuberculosis hospital No. 2» of Saint Petersburg during the period from 2006 to 2018 was conducted.Results and discussion. It was concluded that a mean protein level in CSF was 1,6±0,1 g/l and was significantly increased in patients with tubercular meningoencephalomyelitis. When decreasing the amount of CD4-lymphocytes, increasing of protein level in cerebrospinal fluid is observed. As cytosis increases, the amount of neutrophils increases too. Patients with tuberculous meningitis showed remarkable pleocytosis in comparison with patients with meningocephalitis. In 47% of cases, neutrophilic cell composition of CSF was registered. Therewith, the rate of neutrophils in CSF increased as the rate of lymphocytes decreased. Reducing of glucose in CSF was observed in the majority of patients with CNS tuberculosis independently of severity of immunosuppression and extent of brain injury.
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- 2021
16. Grande International Hospital Researchers Describe New Findings in Meningitis (Magnetic resonance imaging findings in central nervous system tuberculosis: A pictorial review).
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TUBERCULOUS meningitis ,MAGNETIC resonance imaging ,CENTRAL nervous system ,CENTRAL nervous system infections ,TUBERCULOSIS ,MENINGITIS - Abstract
Researchers from Grande International Hospital in Kathmandu, Nepal have conducted a study on central nervous system (CNS) tuberculosis, a post-primary form of tuberculosis that has high mortality and morbidity rates. The study explores the various imaging presentations of CNS tuberculosis using magnetic resonance imaging (MRI) and discusses recent advances in imaging techniques. The researchers found that certain MRI sequences, such as post-contrast 3D fluid-attenuated inversion recovery (FLAIR) and post-contrast T1 spin-echo sequences, are effective in detecting tuberculous meningitis. They also highlight the use of magnetization transfer (MT) imaging to enhance the detection of tuberculous lesions. This review article provides valuable insights into the diagnosis and imaging of CNS tuberculosis. [Extracted from the article]
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- 2024
17. Cognitive Impairment in Tuberculous Meningitis.
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Davis, Angharad G, Dreyer, Anna J, Albertyn, Christine, Maxebengula, Mpumi, Stek, Cari, Wasserman, Sean, Marais, Suzaan, Bateman, Kathleen, Solms, Mark, Joska, John, Wilkinson, Robert J, and Nightingale, Sam
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COGNITION disorders diagnosis ,HIV infection complications ,CLINICAL drug trials ,COGNITION disorders ,FUNCTIONAL assessment ,COMPARATIVE studies ,RESEARCH funding ,DESCRIPTIVE statistics ,COGNITIVE testing ,PATIENT compliance ,PSYCHOLOGY of HIV-positive persons - Abstract
Background Cognitive impairment is reported as a common complication in adult tuberculous meningitis (TBM), yet few studies have systematically assessed the frequency and nature of impairment. Moreover, the impact of impairment on functioning and medication adherence has not been described. Methods A cognitive test battery (10 measures assessing 7 cognitive domains) was administered to 34 participants with human immunodeficiency virus (HIV)–associated TBM 6 months after diagnosis. Cognitive performance was compared with that a comparator group of 66 people with HIV without a history of tuberculosis. A secondary comparison was made between participants with TBM and 26 participants with HIV 6 months after diagnosis of tuberculosis outside the central nervous system (CNS). Impact on functioning was evaluated, including through assessment of medication adherence. Results Of 34 participants with TBM, 16 (47%) had low performance on cognitive testing. Cognition was impaired across all domains. Global cognitive performance was significantly lower in participants with TBM than in people with HIV (mean T score, 41 vs 48, respectively; P <.001). These participants also had lower global cognition scores than those with non-CNS tuberculosis (mean global T score, 41 vs 46; P =.02). Functional outcomes were not significantly correlated with cognitive performance in the subgroup of participants in whom this was assessed (n = 19). Conclusions Low cognitive performance following HIV-associated TBM is common. This effect is independent of, and additional to, effects of HIV and non-CNS tuberculosis disease. Further studies are needed to understand longer-term outcomes, clarify the association with treatment adherence, a key predictor of outcome in TBM, and develop context-specific tools to identify individuals with cognitive difficulties in order to improve outcomes in TBM. [ABSTRACT FROM AUTHOR]
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- 2023
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18. Computed tomography in CNS tuberculosis
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Wolfgang Kluge, Robert Loddenkemper, Matthias Trautmann, and Hans-Siegfried Otto
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,education ,Tuberculous meningitis ,Cerebral edema ,Diagnosis, Differential ,medicine.artery ,medicine ,Humans ,Tuberculoma ,Aged ,Brain Diseases ,business.industry ,Cerebral infarction ,Infant ,Middle Aged ,medicine.disease ,Hydrocephalus ,Neurology ,Child, Preschool ,Tuberculosis, Meningeal ,Middle cerebral artery ,Female ,Neurology (clinical) ,Radiology ,business ,Tomography, X-Ray Computed ,Meningitis ,Encephalitis - Abstract
Computed tomography (CT) was performed in 14 cases of tuberculous meningitis (TBM), 12 of which were examined during the acute phase of the disease. CT findings in these cases included internal hydrocephalus (6/12), internal combined with external hydrocephalus (2/12), focal lesions consistent with localized encephalitis (3/12), diffuse brain edema (1/12), and middle cerebral artery infarction (1/12). In comparison to 32 cases of nonspecific bacterial meningitis, internal hydrocephalus was found significantly more often in TBM than in nonspecific meningitis (p less than 0.01) making CT an additional tool for the differentiation of these conditions in doubtful cases. In addition, CT features of 2 cases of cerebral tuberculoma are presented.
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- 1986
19. Emerging Infections of the Central Nervous System
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Lyons, Jennifer and McArthur, Justin
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- 2013
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20. Tuberkulöse Meningitis
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Schuchardt, V. and Prange, H.
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- 2005
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21. Meningoencefalite tuberculosa: avaliação de 231 casos Tuberculosis meningoencephalitis: exposure of 231 cases
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Ceuci Nunes, Sérgio Cunha, Nilton Gomes, Adelci Tavares, Dilcinéia Amorim, Irênio Gomes, and Ailton Melo
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Meningoencefalite tuberculosa ,Meningite tuberculosa ,Tuberculose do SNC ,Tuberculose ,Tuberculous meningoencephalitis ,Tuberculous meningitis ,CNS tuberculosis ,Tuberculosis ,Arctic medicine. Tropical medicine ,RC955-962 - Abstract
Neste estudo foram avaliados 231 pacientes com meningoencefalite tuberculosa, sendo que 62 casos tiveram diagnóstico comprovado e 169 apresentavam quadro clínico e laboratorial compatíveis com este diagnóstico. Foram 127 (55%) pacientes do sexo masculino, a idade variou de 1 mês a 68 anos, com 97 (42%) na faixa etária igual ou inferior a um ano. As características clínicas, demográficas e liquóricas foram estudadas e comparadas entre os casos confirmados e os de diagnóstico provável. Em conclusão reafirmamos a gravidade desta doença, com altas taxas de letalidade principalmente na faixa etária de zero a quatro anos e a possibilidade de erros diagnósticos nas apresentações com formas agudas e predominância de neutrófilos no líquor.This study assessed 231 cases of tuberculous meningitis of which 62 (26.8%) had diagnostic confirmation against 169 (73.2%) with only clinical picture and laboratorial indication for this diagnosis. Fifty-five percent of the sample was male; ages ranged from one month to 68 years, 42% comprising children below four years.Clinical, demographic and liquoric characteristics were investigated and compared amongst those with likely and confirmed diagnosis. In conclusion, atention is drawn to the severity of this desease with high rates of lethality mainly within the age-range of 0-4 years, and to the possibility of misdiagnosis in the presentation of acute forms and predominance of neutrophils in the liquor.
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- 1998
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22. Neuroimaging Changes and Treatment Outcome of Tubercular Meningitis-Experiences 22 Cases in a Tertiary Care Center.
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KUNDU, G. K., ZAHAN, G. A., SARKER, M. A., and DOLA, F. N.
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TUBERCULOUS meningitis ,SYMPTOMS ,TREATMENT effectiveness ,PEDIATRIC neurology ,TERTIARY care ,MYCOBACTERIUM tuberculosis - Abstract
Background: Tuberculous meningitis (TBM) is caused by Mycobacterium tuberculosis (M. tuberculosis) and is the most common form of central nervous system (CNS) tuberculosis (TB). The prevalence of TB meningitis remains largely underestimated because clinical manifestations are nonspecific in early stages of the disease. Prompt diagnosis is critical for initiating appropriate therapy, facilitating measures to prevent dissemination of this highly contagious disease and to combat fatal complication in children Aims: To evaluate the role of neuroimaging changes and treatment outcome of tubercular meningitis. Methods: This prospective hospital-based cohort study was conducted in Department of Paediatric Neurology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, during January 2022 to December 2022. Children age belonged to 1 month to 10 year diagnosed as TBM during study period were enrolled in this study. Detailed history, clinical examination, CSF analysis and other relevant investigations were done. Data were recorded in standard questionnaire. Statistical analyses of the results were obtained by using windowbased computer software devised with Statistical Packages for Social Sciences (SPSS-22). Results: Total 22 diagnosed case of TBM was enrolled and evaluated. Among them two third (63.63%) children were in 5-10 year age group. Male (59%) were outnumbered than female (36.36 %). Male female ratio was 1.6:1. More than half (59%) of patients came from urban area. All of the patients were vaccinated. Cent percent (100%) patients were presented with fever followed by headache (77.27%), sign of meningeal irritation (54.54%), vomiting (54.54%) and seizures (50%). Most common complication was hemiparesis (45.45%) followed by cranial nerve palsy (40.90%), visual problem (9.09%) and hydrocephalus (4.54%). Abnormal neuroimaging changes were found in 100% cases. Common findings were hydrocephalus (40.90%), tubercloma (36.36%), basilar enhancement (18.18%), Benign enlargement of subdural space & cerebellar hyperintensity (9%) and thalamic infract was present in 4.54% cases. Anti TB and steroid treatment were given in 100% cases and among them18.18% cases were required shunt procedure. More than one-third cases (40.90%) were completely normal without any no sequelae. Among abnormal sequelae found in two third (59%) cases. Speech impairment (36.36%) was most common followed by GDD (18.18%), hemiparesis (13.63%), quadriparesis (9.09%) and epilepsy in 9.09% cases. Conclusion: In our study all children of TBM were presented with fever followed by other predominant clinical features headache, vomiting, seizures and sign of meningeal irritation. Abnormal neuroimaging changes were found in all cases. Common findings were basilar enhancement, hydrocephalus, tubercloma, benign enlargement of subdural space & cerebellar hyper intensity and thalamic infract. After treatment more than one-third cases were completely normal without any no sequelae. [ABSTRACT FROM AUTHOR]
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- 2024
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23. Antituberculars: Paradoxical worsening of CNS tuberculosis: case report.
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TUBERCULOUS meningitis , *TUBERCULOSIS , *SYSTEMIC lupus erythematosus - Published
- 2022
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24. Drug Resistance in Children with Central Nervous System Tuberculosis from a Tertiary Care Center in Mumbai.
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Mane, Sushant S, Janardhanan, Jyothi, Pustake, Manas, Ali, Mohammed Kashif, and Khan, Gazi Israil
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TUBERCULOSIS , *DRUG resistance , *TERTIARY care , *DAY care centers , *DEMOGRAPHIC characteristics , *PATIENT compliance , *TUBERCULOSIS epidemiology , *TUBERCULOSIS diagnosis , *DRUG therapy for tuberculosis , *SPECIALTY hospitals , *MYCOBACTERIUM tuberculosis , *ANTITUBERCULAR agents , *DRUG resistance in microorganisms , *MICROBIAL sensitivity tests , *PHARMACODYNAMICS - Abstract
Introduction: Central Nervous System tuberculosis (CNS-TB) is the most lethal form of extra-pulmonary TB, especially in children. In this study, we have discussed patterns of drug resistance in pediatric CNS-TB.Materials and Methods: Prospective observational study conducted on 100 children at a tertiary care center. Diagnosed cases of CNS-TB were enrolled. GeneXpert MTB/RIF was used upfront for diagnosis, and in cases where TB MGIT culture was positive, a phenotypic Drug Susceptibility Test (DST) was done. Patients were divided into resistant to at least one drug (DR) and drug-susceptible (DS). Various parameters were compared between these groups.Results: Mean age of participants was 5.84 ± 3.5 years, with a male-to-female ratio of 1.08 : 1; 14% of children had drug-resistant CNS TB (DR-CNS-TB). A higher proportion of children previously treated for TB were associated with drug resistance (p = 0.009), and those with disseminated TB also had a higher drug resistance (p = 0.002). Apart from this, the DR and DS groups had no statistically significant differences in demographic, clinical or epidemiological parameters.Conclusions: Previous history of being treated for TB and disseminated TB was an independent risk factor for DR-CNS-TB. Ensuring proper adherence and compliance to anti-tubercular treatment could help in preventing the emergence of DR TB. [ABSTRACT FROM AUTHOR]- Published
- 2021
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25. Tuberculome cérébral un challenge diagnostic: à propos d’un cas et mise au point
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Nizar El Fatemi, Patrice Niamien Koffi, Rachid El Maaquili, and Olivier Ouambi
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Cerebral tuberculoma ,medicine.medical_specialty ,spectroscopy ,brain MRI ,030231 tropical medicine ,Physical examination ,Case Report ,Tuberculous meningitis ,spectroscopie ,Lesion ,03 medical and health sciences ,0302 clinical medicine ,IRM cérébrale ,central nervous system (CNS) tuberculosis ,medicine ,030212 general & internal medicine ,medicine.diagnostic_test ,business.industry ,Glasgow Coma Scale ,General Medicine ,tuberculose du système nerveux central ,medicine.disease ,Maroc ,Morocco ,Hemiparesis ,Vomiting ,Tuberculoma ,Radiology ,medicine.symptom ,Headaches ,Tuberculome cérébral ,business - Abstract
La tuberculose du système nerveux central est le deuxième site le plus fréquent après la méningite tuberculeuse. Elle est une cause majeure de morbidité et de mortalité dans les pays en développement et représente 10 à 30% des lésions expansives intracrâniennes dans ces pays contre 0,2% dans certains pays occidentaux. Le but de cet article est de présenter un cas atypique de tuberculome cérébral dans sa présentation clinique et radiologique (l'IRM cérébrale et de la spectroscopie), de faire une mise au point à partir de cette observation sur cette pathologie infectieuse. Il s'agit d'une patiente de 44 ans, sans antécédent médico-chirurgical, qui a présenté depuis un an des céphalées, compliquées 08 mois après de crises d'épilepsies partielles à généralisation secondaire et de lourdeur de l'hémicorps gauche avec des épisodes de vomissements sans trouble visuel ni fièvre ni altération de l'état général. L'examen clinique trouvait une patiente consciente GCS= 15, pupilles égales et réactives, station debout et marche possible sans anomalie, avec hémiparésie gauche 4/5 sans autres signes neurologiques. L'IRM cérébrale objectivait en séquence T1 non injectée une lésion pariétale droite sus tentoriel plurilobées iso intense mal limitée, en séquence T2 elle est hétérogène avec un liseré hyper intense et un fond hypo intense traduisant un processus charnu avec des zones de nécroses centrales et un œdème péri-lésionnel en doigt de gans en séquence FLAIR, avec une prise de contraste annulaire intense après injection de gadolinium. L'analyse de la spectroscopie était en faveur d'une tumeur gliale. La patiente fut mise sous anticonvulsivant et a bénéficié d'un abord direct avec exérèse macroscopiquement complète. L'analyse anatomopathologique était en faveur d'un tuberculome cérébral. Elle a été mise sous traitement antituberculeux avec arrêt des crises et récupération du déficit après 04 semaines. A travers ce cas nous entrevoyons le polymorphisme clinique et radiologique qu'est le tuberculome cérébral. Il est évoqué devant un faisceau d'argument clinique, biologique et radiologique mais le diagnostic de certitude reste essentiellement anatomopathologique. La prise en charge ne saurait tarder car les complications sont néfastes et de mauvais pronostic lorsqu'il est détecté tardivement.
- Published
- 2019
26. TO EVALUATE THE SENSITIVITY AND SPECIFICITY OF CSF-ADA AS A DIAGNOSTIC TOOL IN TUBERCULOSIS MENINGITIS
- Author
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Ishan Parasher, Shrawan Kumar, Karthic Chandran, Pranjal Pankaj, and Manish Kumar Singh
- Subjects
medicine.medical_specialty ,Tuberculosis ,biology ,Tuberculosis Meningitis ,business.industry ,Aseptic meningitis ,medicine.disease ,Tuberculous meningitis ,Adenosine deaminase ,Cerebrospinal fluid ,Internal medicine ,CNS TUBERCULOSIS ,medicine ,biology.protein ,business ,Meningitis - Abstract
INTRODUCTION: Tuberculosis remains one of the world’s deadliest diseases & tubercular meningitis is one of the most deadly complications due to missed diagnosis and delayed treatment result in significant morbidity and mortality. The signs and symptoms, results of routine analysis of CSF and radiographic findings for patients with CNS tuberculosis are often inadequate in making a definitive diagnosis. AIMS AND OBJECTIVES: 1. To study the levels of Adenosine deaminase in cases of meningitis, 2. To evaluate the sensitivity and specificity of CSF-ADA as a diagnostic test in tuberculosis meningitis. MATERIAL AND METHODS: In the cross sectional study, Adenosine deaminase activity (ADA) was studied in cerebrospinal fluid of 60 cases of tuberculous meningitis, 10 cases of pyogenic meningitis. 10 cases of aseptic meningitis and15 control. RESULTS: The mean CSF-ADA activity was 14.1±1.96 (tuberculous meningitis); 4.92±1.27 (pyogenic meningitis); 3.66±1.03 (aseptic meningitis) and 1.69±0.44 U/l (control) respectively. The sensitivity and specificity of this test for diagnosis of tuberculous meningitis was 100% and 97.44% respectively with ADA value of more than 10 U/L. CONCLUSION: The adenosine deaminase activity in tuberculous meningitis cases was significantly higher. So it can be of great value in the early and more definitive diagnosis of tuberculous meningitis, to help early diagnosis and treatment to prevent from deadly complications of tubercular meningitis.
- Published
- 2013
27. Multiple tuberculomas and cavitating pulmonary tuberculosis in an infant.
- Author
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Peterson, Rachel, Ramya, R, Kuruvilla, Asha, and Lakshmi, K
- Subjects
- *
TUBERCULOMA , *TUBERCULOSIS , *INFANTS , *COUGH , *TUBERCULOUS meningitis , *PRIMARY immunodeficiency diseases , *CENTRAL nervous system - Abstract
A five-month-old infant presented with fever and cough for 3 weeks. She was diagnosed with multiple tuberculomas and cavitating pulmonary tuberculosis. She was a household contact of an open case of tuberculosis (TB) and developed severe disease, although she had received the Bacillus Calmette–Guérin (BCG) vaccine and had no primary or secondary immunodeficiency. In infants, due to low levels of cell mediated immunity, tuberculosis can be severe and dissemination of tuberculosis to the central nervous system (CNS) can occur very early without following the usual time frame. CNS TB may not have symptoms in the early stages in infants and may require neuroimaging for diagnosis. This is the youngest child that has been reported with multiple CNS tuberculomas. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
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28. Mycobacterium tuberculosis Infection Induces BCSFB Disruption but No BBB Disruption In Vivo: Implications in the Pathophysiology of Tuberculous Meningitis.
- Author
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Sánchez-Garibay, Carlos, Salinas-Lara, Citlaltepetl, Gómez-López, Marcos Artemio, Soto-Rojas, Luis O., Castillón-Benavides, Nidia Karen, Castillón-Benavides, Omar Jorge, Hernández-Campos, María Elena, Hernández-Pando, Rogelio, Marquina-Castillo, Brenda, Flores-Barrada, Manuel Alejandro, Choreño-Parra, José Alberto, León-Contreras, Juan Carlos, Tena-Suck, Martha Lilia, Mata-Espinosa, Dulce Adriana, Nava, Porfirio, Medina-Mendoza, Jessica, and Rodríguez-Balderas, Cesar Augusto
- Subjects
TUBERCULOUS meningitis ,TUBERCULOSIS ,MYCOBACTERIUM tuberculosis ,MYCOBACTERIAL diseases ,CENTRAL nervous system ,CHOROID plexus ,PATHOLOGICAL physiology - Abstract
Central nervous system (CNS) tuberculosis is the most lethal and devastating form among the diseases caused by Mycobacterium tuberculosis. The mechanisms by which M. tuberculosis bacilli enter the CNS are still unclear. However, the BBB and the BCSFB have been proposed as possible routes of access into the brain. We previously reported that certain strains of M. tuberculosis possess an enhanced ability to cause secondary CNS infection in a mouse model of progressive pulmonary tuberculosis. Here, we evaluated the morphostructural and molecular integrity of CNS barriers. For this purpose, we analyzed through transmission electron microscopy the ultrastructure of brain parenchymal microvessels and choroid plexus epithelium from animals infected with two mycobacterial strains. Additionally, we determined the expression of junctional proteins and cytokines by immunological techniques. The results showed that the presence of M. tuberculosis induced disruption of the BCSFB but no disruption of the BBB, and that the severity of such damage was related to the strain used, suggesting that variations in the ability to cause CNS disease among distinct strains of bacteria may also be linked to their capacity to cause direct or indirect disruption of these barriers. Understanding the pathophysiological mechanisms involved in CNS tuberculosis may facilitate the establishment of new biomarkers and therapeutic targets. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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29. MRI in intracranial tuberculosis: Have we seen it all?
- Author
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Baloji, Abhiman and Ghasi, Rohini Gupta
- Subjects
- *
TUBERCULOSIS , *HIV infections , *DIAGNOSTIC imaging , *OVERPOPULATION , *POPULATION geography , *SPINAL tuberculosis - Abstract
Tuberculosis is emerging worldwide across diverse populations and geographies; unrestricted by the social divide and the geographical barriers in today's interconnected world. This rise in its prevalence can be linked to multiple factors including urbanisation, spurt in global travel, population explosion, migration and HIV infection. The varied and complex clinical presentation of intracranial tuberculosis tricks even the best of the clinicians. This along with the other facets associated with its management including drug resistance, paradoxical reaction, underlying HIV infection can make it particularly challenging. Imaging has a definitive role in the evaluation and follow-up of intracranial tuberculosis and MRI is the cornerstone in this regard. Typical features of intracranial tuberculosis are well-described. However, it is not infrequent to encounter atypical and bizarre presentations, both clinically and on imaging. A holistic clinical and imaging review of difficult cases, including newer MRI techniques, is necessary for the neuroradiologist, neurologist and the neurosurgeon to arrive at the right diagnosis in a timely fashion. • Intracranial tuberculosis is emerging across the globe. • Imaging studies, particularly MRI is the cornerstone in the diagnosis. • Typical and atypical features contribute to a diverse imaging pattern. • Knowledge of the various possibilities and advanced MRI techniques is essential. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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30. Involvement of the Choroid Plexus in Neurotuberculosis: MR Findings in Six Cases
- Author
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Dibyajyoti Boruah, Jayantee Kalita, A. Bhattacharyya, Vivek Singh, Akash Handique, U.K. Misra, and R.V. Vishnu Phadke
- Subjects
Pathology ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,General Medicine ,medicine.disease ,eye diseases ,Tuberculous meningitis ,Hydrocephalus ,Edema ,CNS TUBERCULOSIS ,medicine ,Radiology, Nuclear Medicine and imaging ,Choroid plexus ,sense organs ,Neurology (clinical) ,medicine.symptom ,business ,Meningitis - Abstract
The majority of intracranial infections that cause meningitis are considered to start in the choroid plexus of the ventricles, but lesions involving the choroid plexus are rare. There are isolated case reports of the involvement of choroid plexus in tuberculous meningitis. The main imaging findings are abnormal enhancement of the thickened choroid plexus, asymmetric hydrocephalus with sequestrated temporal horn, periventricular edema and intraventricular septae formation. Six patients having tubercular involvement of choroid plexus were treated at our institution. This is probably the largest series of tubercular involvement of choroid plexus highlighting the imaging features of this rare manifestation of CNS tuberculosis.
- Published
- 2010
31. Disseminated central nervous system tuberculoma in a patient with scrub typhus: A case report.
- Author
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Yu, Yachun and He, Guohua
- Subjects
TSUTSUGAMUSHI disease ,TUBERCULOUS meningitis ,CENTRAL nervous system ,TUBERCULOMA ,MYCOBACTERIUM tuberculosis ,SPINAL cord - Abstract
Central nervous system (CNS) tuberculosis mainly manifests as tuberculous meningitis and intracranial tuberculosis; intramedullary tuberculosis is uncommon. Scrub typhus is an acute naturally occurring infectious disease caused by Orientia tsutsugamushi. CNS tuberculoma following typhus is rare. The present study described a 60-year-old man with high fever, muscle soreness, yellowish skin and sclera and hepatosplenomegaly. At first, the patient was diagnosed with scrub typhus, after treatment with doxycycline he recovered completely. However, half a month after discharge, the patient experienced headache, night sweats and anorexia. Tuberculosis-specific enzyme-linked immunospot assay showed positive Mycobacterium tuberculosis antibody in cerebrospinal fluid (CSF). Metagenomic next-generation sequencing detected the presence of Mycobacterium tuberculosis in CSF. Magnetic resonance imaging of the brain and spinal cord showed multiple rings enhancing lesions in the cerebral hemispheres, cerebellum, brainstem and spinal cords. After the diagnosis of CNS tuberculoma, the patient was started on conventional anti-tuberculosis therapy resulting in a good prognosis. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
32. Diagnóstico da tuberculose do sistema nervoso central por MPB64-Target PCR
- Author
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Mushtaq A. Siddiqi, Dil-Afroze, Shakeel-ul-Rehman, Altaf Rehman Kirmani, Rafiqa Eachkoti, and Abdul Waheed Mir
- Subjects
Pathology ,medicine.medical_specialty ,Tuberculosis ,Disease ,Microbiology ,Tuberculous meningitis ,tuberculose do sistema nervoso central ,Mycobacterium tuberculosis ,Cerebrospinal fluid ,Immune system ,Medicine ,CNS tuberculosis ,tuberculomas intracraniais ,intracranial tuberculomas ,biology ,business.industry ,meningite tuberculosa ,biology.organism_classification ,medicine.disease ,tuberculous meningitis (TBM) ,PCR ,Delayed hypersensitivity ,Medical Microbiology ,business ,Meningitis ,Research Paper - Abstract
Central nervous system (CNS) tuberculosis is a serious clinical problem, the treatment of which is sometimes hampered by delayed diagnosis. Clearly, prompt laboratory diagnosis is of vital importance as the spectrum of disease is wideand abnormalities of the cerebrospinal fluid (CSF) are incredibly variable. Since delayed hypersensitivity is the underlying immune response, bacterial load is very low. The conventional bacteriological methods rarely detect Mycobacterium tuberculosis in CSF and are of limited use in diagnosis of tuberculous meningitis (TBM). This double blind study was, therefore, directed to the molecular analysis of CNS tuberculosis by an in-house-developed PCR targeted for amplification of a 240bp nucleotidesequence coding for MPB64 protein specific for Mycobacterium tuberculosis. Based on the clinical criteria, 47 patients with CNS tuberculosis and a control group of 10 patients having non-tubercular lesions of the CNS were included in the study. Analyses were done in three groups; one group consisting of 27 patients of TBM, a second group of 20 patients with intracranial tuberculomas and a third group of 10 patients having non-tubercular lesions of the CNS acted as control. There were no false positive results by PCR and the specificity worked out to be 100%. In the three study groups, routine CSF analysis (cells and chemistry), CSF for AFB smear and culture were negative in all cases. PCR was positive for 21/27 patients (77.7% sensitivity) of the first group of TBM patients, 6/20 patients (30% sensitivity) of the second group with intracranial tuberculomas were positive by PCR and none was PCR-positive (100% specificity) in the third group. Thus, PCR was found to be more sensitive than any other conventional method in the diagnosis of clinically suspected tubercular meningitis. A tuberculose do sistema nervoso central (CNS) é um problema clínico sério, cujo tratamento é dificultado pelo diagnóstico tardio. O diagnóstico laboratorial rápido é de importância vital considerando que o espectro da doença é amplo e as anormalidades do liquor são muito variáveis. Considerando que a hipersensibilidade tardia é a resposta imune fundamental, a carga bacteriana é muito baixa. Os métodos bacteriológicos convencionais raramente detectam Mycobacterium tuberculosis no liquor e são de uso limitado para diagnóstico da meningite tuberculosa (TBM). O presente estudo duplo-cego objetivou a análise molecular da tuberculose do CNS através de um PCR desenvolvido in-house direcionado para a amplificação de uma seqüência de nucleotídios de 240pb que codificam a proteína MPB64 especifica de Mycobacterium tuberculosis. Baseando-se em critérios clínicos, selecionou-se 47 pacientes com tuberculose do CNS e um grupo controle de 10 pacientes com lesões não-tuberculosas no CNS. As análises foram divididas em três grupos: um grupo de 27 pacientes com TBM, um segundo grupo com 20 pacientes com tuberculomas intracraniais e um terceiro grupo de 10 pacientes com lesões não-tuberculosas no CNS (controles). O PCR não forneceu nenhum resultado falso-positivo, com 100% de especificidade. Em todos os três grupos de estudo, os resultados das análises de rotina do liquor por histologia, química e baciloscopia e também cultura foram negativos em todos os casos. No primeiro grupo de pacientes com TBM, PCR foi positivo em 21/27 pacientes (sensibilidade de 77,7%). No segundo grupo de pacientes com tuberculomas intracraniais, 6/20 foram positivos (sensibilidade de 30%). Nenhum dos pacientes do grupo controle foi positivo (100% de especificidade). Dessa forma, o PCR mostrou-se mais sensível que os métodos convencionais no diagnóstico de casos suspeitos de meningite tuberculosa.
- Published
- 2007
33. Clinicoradiological features of tuberculous meningitis in patients over 50 years of age
- Author
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Arun B Taly, Krishnan Nagarajan, S. G. Srikanth, S Patil, and Peruvumba N. Jayakumar
- Subjects
Male ,medicine.medical_specialty ,Pediatrics ,Tuberculosis ,Short Report ,Tuberculous meningitis ,Basal (phylogenetics) ,medicine ,Humans ,In patient ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Surgery ,Hydrocephalus ,Psychiatry and Mental health ,Tuberculosis, Meningeal ,CNS TUBERCULOSIS ,Female ,Neurology (clinical) ,Tomography, X-Ray Computed ,business ,Meningitis - Abstract
Background and aim: Tuberculous meningitis (TBM) is a debilitating form of CNS tuberculosis with a high morbidity and mortality in spite of treatment. The diagnosis is based on clinical, radiological and laboratory features. The classical CT features of basal exudates, hydrocephalus, infarcts and granulomas have been mostly reported in younger individuals. Our aim was to study imaging features of TB meningitis in adults over the age of 50 years. Materials and methods: Clinical, imaging and laboratory features of 53 adult patients over the age of 50 years (sixth to eighth decades) were studied retrospectively. Diagnosis of TBM was based on clinical and laboratory features. Results: Imaging features were the conspicuous absence of typical features of TBM (ie, basal meningeal enhancement, hydrocephalus, infarcts/granulomas were seen in only a minority of patients). Conclusions: CT features of TBM in elderly patients were few, atypical and non-contributory for diagnosis, probably because of age related immune senescence. Strong clinical suspicion and correlation with laboratory findings is necessary for early diagnosis.
- Published
- 2006
34. Unusual fundus examination findings in tuberculous meningitis
- Author
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Rajesh Verma and Tejendra S Chaudhari
- Subjects
Adult ,Pathology ,medicine.medical_specialty ,Tuberculosis ,genetic structures ,Central nervous system ,Fundus (eye) ,Tuberculous meningitis ,Article ,Ophthalmoscopy ,Young Adult ,Atrophy ,medicine ,Humans ,medicine.diagnostic_test ,business.industry ,General Medicine ,medicine.disease ,Pathophysiology ,eye diseases ,Optic Atrophy ,medicine.anatomical_structure ,Tuberculosis, Meningeal ,CNS TUBERCULOSIS ,Female ,business - Abstract
Vision impairment is one of the devastating complications of central nervous system tuberculosis (CNS TB). Optic atrophy is a sequelae of various forms of CNS TB which, ultimately, is responsible for vision impairment. It is usually the secondary optic atrophy which occurs in CNS TB. In this case report, we present two cases of CNS tuberculosis developing primary optic atrophy, which is infrequently reported. The relevant pathophysiology and causes of vision impairment in CNS TB are also discussed.
- Published
- 2013
35. Tuberculosis of the central nervous system in children
- Author
-
Jeffrey R. Starke
- Subjects
Pediatrics ,medicine.medical_specialty ,Tuberculosis ,Central nervous system ,Antitubercular Agents ,Infarction ,Tuberculous meningitis ,Mycobacterium tuberculosis ,Diagnosis, Differential ,medicine ,Humans ,Child ,biology ,business.industry ,Public health ,Tuberculosis, Central Nervous System ,biology.organism_classification ,medicine.disease ,United States ,medicine.anatomical_structure ,Pediatrics, Perinatology and Child Health ,CNS TUBERCULOSIS ,Immunology ,Neurology (clinical) ,business ,Vasculitis - Abstract
Tuberculosis remains one of the most common and important infectious diseases in the world. Between 1% and 2% of children with untreated tuberculosis infection will develop tuberculous meningitis. In 1997, 186 cases of tuberculous meningitis were reported in the United States. The initial clinical manifestations of tuberculous meningitis are protean, making early disease difficult to recognize. The clinical and radiographic manifestations of tuberculous meningitis result from the combination of basilar meningitis, infarction, and vasculitis. Early diagnosis can be problematic as Mycobacterium tuberculosis is difficult to detect by rapid tests. Although the response to antituberculosis chemotherapy is generally favorable, complications commonly occur, particularly if the diagnosis is delayed. With appropriate public health management of known tuberculosis cases, cases of CNS tuberculosis in children can be prevented.
- Published
- 2000
36. Importance of differentiating Mycobaterium bovis in tuberculous meningitis
- Author
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José Sifuentes Osornio, Alfredo Ponce de León, and Alejandra González-Duarte
- Subjects
medicine.medical_specialty ,lcsh:Internal medicine ,Tuberculosis ,Human immunodeficiency virus (HIV) ,lcsh:Medicine ,medicine.disease_cause ,Diagnostic tools ,Tuberculous meningitis ,Article ,lcsh:RC321-571 ,Mycobacterium tuberculosis ,Internal medicine ,M. tuberculosis ,Medicine ,Stage (cooking) ,Medical diagnosis ,lcsh:RC31-1245 ,lcsh:Neurosciences. Biological psychiatry. Neuropsychiatry ,CNS tuberculosis ,Mycobacterium bovis ,biology ,business.industry ,M. bovis ,lcsh:R ,medicine.disease ,biology.organism_classification ,tuberculosis ,tuberculous meningitis ,Immunology ,Neurology (clinical) ,business - Abstract
The aim of the article is to describe the principal findings among patients with M.tuberculosis and M. bovis CNS infection. Mycoba - cterium tuberculosis is one of the most common infectious agents that cause death and neurological sequelae around the world. Most of the complications of CNS TB can be attributed to a delay in the diagnosis. Unfortu nately, there are no specific diagnostic tools to support an early diagnosis. Other prognostic factors different from delay in treatment have not been identified. Clinical, radiological and laboratory characteristics were analyzed retrospectively from the medical files of all the patients admitted with the diagnoses of tuberculosis. Of 215 patients admitted with systemic tuberculosis, 64 (30%) had a neurological infection. Positive cultures were found in 54 (84%) cases, 18 (33%) in the CSF and the rest in other fluids or tissues. Adenosin deaminase (ADA) enzyme determination was more sensitive than M. tuberculosis PCR in the CSF for supporting an early diagnosis. In addition to a later clinical stage and treatment lag, positive CSF cultures (P=0.001) and the presence of M. bovis (P=0.020) were prognostic factors for a worse outcome. Neither older age, the presence of tuberculomas versus meningeal enhancement, or HIV co-infection, was associated to a worse prognosis. The isolation of M. bovis subspecies was more common that previously reported, and it was associated to the development of parenchymal lesions (P=0.032) when compared to M. tuberculosis. In this study, positive CSF cultures for M. tuberculosis and further identifying M. bovis species were additional prognostic factors for worse outcome. Positive cultures in systemic fluids other than CSF, even when the patient had no obvious systemic manifestations, and ADA determination in the CSF were noteworthy diagnostic tools for the diagnosis.
- Published
- 2011
37. Tuberculosis of the nervous system: a modern problem.
- Author
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Lok-Ming Tang and Swash, Michael
- Subjects
CENTRAL nervous system diseases ,TUBERCULOSIS ,TUBERCULOUS meningitis ,CEREBROSPINAL fluid ,STEROID drugs - Abstract
The article provides information on central nervous system (CNS) tuberculosis. It explains the importance of cerobrospinal fluid examination in the diagnosis of tuberculous meningitis (TBM). Steroids have been utilized for the treatment of TBM because of its anti-inflammatory and antioedematous effects. It cites the prescribed drugs for the treatment of CNS tuberculosis.
- Published
- 1985
- Full Text
- View/download PDF
38. Paradoxical manifestations during tuberculous meningitis treatment among HIV-negative patients: a retrospective descriptive study and literature review.
- Author
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Domínguez-Moreno, Rogelio, García-Grimshaw, Miguel, Medina-Julio, David, Cantú-Brito, Carlos, and González-Duarte, Alejandra
- Abstract
Background: Tuberculous meningitis (TBM) is the most frequent, severe, and disabling form of central nervous system (CNS) tuberculosis (TB). TBM paradoxical manifestations are characterized by clinical or paraclinical worsening after 1 month of effective anti-TB treatment in patients who initially responded to treatment despite the use of adjunctive corticosteroids. Methods: Retrospective descriptive study of consecutive HIV-negative adult patients (≥ 18 years) with definitive TBM who developed a paradoxical manifestation following anti-TB in a tertiary-care hospital in Mexico from 2009 to 2019; we also conducted a literature review of published cases/series of paradoxical manifestations in HIV-negative patients from 1980 to 2020. Results: We detected 84 cases of definitive TBM; 55 (68.7%) HIV-negative patients and 29 (36.3%) HIV-infected patients. Among HIV-negative patients, four (7.3%), three female and one male (19–49 years old), developed a paradoxical manifestation within 4–14 weeks following treatment initiation despite receiving adequate corticosteroid doses; Mycobacterium bovis was isolated from the cerebrospinal fluid of three cases and Mycobacterium tuberculosis in one more. Two patients developed vasculopathy-related cerebral infarctions, one severe basilar meningitis, and hydrocephalus, one more a tuberculoma. Two were treated with intravenous cyclophosphamide, and two with steroids. One of the patients treated with steroids died; patients who received cyclophosphamide had a good clinical response. Conclusions: This case series illustrates the diverse clinical/radiologic paradoxical manifestations of TBM in HIV-negative patients. Cyclophosphamide may be safe and effective in treating TBM-associated paradoxical manifestations. Specific diagnostic and care protocols for these patients are needed. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
39. Meningoencefalite tuberculosa: avaliação de 231 casos
- Author
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Adelci Tavares, Nilton Gomes, Ailton Melo, Ceuci Nunes, Sérgio Souza da Cunha, D. S. Amorim, and Irenio Gomes
- Subjects
Microbiology (medical) ,High rate ,Pediatrics ,medicine.medical_specialty ,business.industry ,Tuberculose do SNC ,Meningite tuberculosa ,Meningoencephalitis ,Disease ,medicine.disease ,Tuberculous meningitis ,Tuberculous meningoencephalitis ,Infectious Diseases ,Meningoencefalite tuberculosa ,medicine ,Tuberculose ,Tuberculosis ,Parasitology ,Presentation (obstetrics) ,business ,CNS tuberculosis - Abstract
Neste estudo foram avaliados 231 pacientes com meningoencefalite tuberculosa, sendo que 62 casos tiveram diagnóstico comprovado e 169 apresentavam quadro clínico e laboratorial compatíveis com este diagnóstico. Foram 127 (55%) pacientes do sexo masculino, a idade variou de 1 mês a 68 anos, com 97 (42%) na faixa etária igual ou inferior a um ano. As características clínicas, demográficas e liquóricas foram estudadas e comparadas entre os casos confirmados e os de diagnóstico provável. Em conclusão reafirmamos a gravidade desta doença, com altas taxas de letalidade principalmente na faixa etária de zero a quatro anos e a possibilidade de erros diagnósticos nas apresentações com formas agudas e predominância de neutrófilos no líquor. This study assessed 231 cases of tuberculous meningitis of which 62 (26.8%) had diagnostic confirmation against 169 (73.2%) with only clinical picture and laboratorial indication for this diagnosis. Fifty-five percent of the sample was male; ages ranged from one month to 68 years, 42% comprising children below four years.Clinical, demographic and liquoric characteristics were investigated and compared amongst those with likely and confirmed diagnosis. In conclusion, atention is drawn to the severity of this desease with high rates of lethality mainly within the age-range of 0-4 years, and to the possibility of misdiagnosis in the presentation of acute forms and predominance of neutrophils in the liquor.
- Published
- 1998
40. Clinical spectrum of active tuberculosis in patients with systemic lupus erythematosus.
- Author
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Muhammed, Hafis, Jain, Avinash, Pattanaik, Sarit Sekhar, Chatterjee, Rudrarpan, Naveen, R., Kabeer, Hina, Gupta, Latika, Misra, Durga P., Agarwal, Vikas, Lawrence, Able, Misra, Ramnath, and Aggarwal, Amita
- Subjects
TUBERCULOSIS patients ,SYSTEMIC lupus erythematosus ,TUBERCULOUS meningitis ,TUBERCULOSIS ,CENTRAL nervous system ,GENDER ,TREATMENT effectiveness - Abstract
Introduction: There is paucity of data on tuberculosis in Indian patients with systemic lupus erythematosus (SLE). We retrospectively studied clinical features and outcome of tuberculosis in SLE. Methods: Medical records of patients who developed tuberculosis simultaneous or after the diagnosis of SLE were retrospectively reviewed. All patients fulfilled 1997 ACR and/or SLICC 2012 classification criteria for SLE. A diagnosis of tuberculosis required bacteriological, histopathological or CT/MRI suggestive of tuberculosis and initiation of four drug antituberculous therapy. Baseline parameters were compared with the rest of cohort to identify predictors of tuberculosis. Results: In our cohort of 1335 SLE patients, 48 (3.6%) developed tuberculosis. Incidence of tuberculosis was calculated to be 733 per 100,000 patient years and occurred after a mean disease duration of 3.0 ± 4.1 years. Extrapulmonary tuberculosis (n = 37) was commoner than pulmonary tuberculosis (n =11). Most common radiological pattern in pulmonary tuberculosis was miliary and musculoskeletal TB was most common extrapulmonary TB. A microbiological diagnosis was obtained in 52.1% patients. Male gender was associated with higher risk of tuberculosis [OR 3.30 (1.55-7.05)]. Mortality was 14.5% and all patients who died had either disseminated (n = 5) or central nervous system (CNS) tuberculosis (n = 2). Conclusion: Incidence of tuberculosis in SLE is higher than general population and is associated with different phenotype and higher mortality. Male gender was associated with increased risk of tuberculosis in SLE. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
41. Post-Infective Hydrocephalus.
- Author
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Garg, Kanwaljeet and Gupta, Deepak
- Subjects
HYDROCEPHALUS ,NEONATAL infections ,VERTICAL transmission (Communicable diseases) ,ANTITUBERCULAR agents ,CEREBROSPINAL fluid shunts ,TUBERCULOUS meningitis ,ASPHYXIA neonatorum ,VENTRICULOCISTERNOSTOMY ,NEUROCYSTICERCOSIS ,MENINGES - Abstract
Background: Post-infective hydrocephalus (PIH) arises as a complication of any CNS infection, and can be either communicating or noncommunicating.Objective: The aim of this article is to study the various causes of PIH and its pathophysiology and treatment.Material and Methods: The literature was searched for articles describing the causes of PIH.Results: Common causes of PIH are CNS tuberculosis (TB), neurocysticercosis, and perinatal or neonatal infection. TBM is most likely to result in hydrocephalus out of all these manifestations of CNS TB, and hydrocephalus is more likely to occur early in the course, typically 4-6 weeks after the onset of TBM, and is more common among children as compared to adults. A trial of medical management (antitubercular therapy, steroids, and decongestants) can be given to patients with communicating hydrocephalus. Ventriculoperitoneal shunt is the most employed method of CSF diversion in these patients. Though traditionally considered contraindicated, many recent studies have found ETV to be a reasonable option in patients with PIH. HCP in patients with neurocysticercosis can be associated with intraventricular cysts and racemose cysts in the basal subarachnoid cisterns. Surgical intervention is required either for cyst removal or CSF diversion. Endoscopic approaches can be used to remove the intraventricular cysts, which takes care of the HCP. PIH in infants can result either from antenatal infections (TORCH infections) or postnatal infections such as meningitis.Conclusions: Management of PIH can be challenging. Management has to be individualized. [ABSTRACT FROM AUTHOR]- Published
- 2021
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42. Cerebral infarction and tuberculoma in central nervous system tuberculosis: frequency and prognostic implications.
- Author
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Wasay, Mohammad, Farooq, Salman, Khowaja, Zubair Ali, Bawa, Zeeshan Ali, Ali, Shehzad Mansoor, Awan, Safia, Asim Beg, M., and Mehndiratta, Man Mohan
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CEREBRAL infarction ,CENTRAL nervous system diseases ,TUBERCULOSIS prognosis ,TERTIARY care ,TUBERCULOUS meningitis ,HYDROCEPHALUS ,HEALTH outcome assessment ,PROGNOSIS - Abstract
Background: Tuberculoma and cerebral infarctions are serious complications of central nervous system (CNS) tuberculosis. However, there are no studies comparing prognostic value of tuberculoma and infarcts alone and in patients diagnosed with CNS tuberculosis. Objective: The objective of this study was to identify frequency and prognostic value of tuberculoma and cerebral infarcts in a large sample of CNS tuberculosis patients. Methods: Retrospective chart review of patients diagnosed with CNS tuberculosis in a tertiary care hospital in Pakistan over 10-year period was carried out. Results: There were 404 patients included in this study (mean age of 43 years). There were 209 (52%) men and 195 (48%) women. Tuberculoma were present in 202 subjects (50%) while infarcts were present in 25% patients. 147 (36%) had tuberculous meningitis (TBM) without tuberculoma or infarction on CT or MRI, 158 (39%) had TBM with intracranial tuberculomas, 60 (15%) had TBM with cerebral infarction while 39 (10%) had TBM with both tuberculoma and infarction. At discharge, 249 patients (62%) were either normal (Modified Rankin Score (MRS)=0) or mild to moderately disabled (MRS=1-3) while 82 patients (20%) had severe disability (MRS=4-5). 73 (18%) patients died (MRS=6) during hospitalisation. Using logistic regression analysis, significant predictors of poor outcome included old age, high TBM grading, presence of infarction and presence of hydrocephalus. Conclusions: Tuberculomas were present in 50% of patients, while infarcts were present in 25%. Old age, TBM grading, presence of infarction and hydrocephalus were all predictors of poor outcome. [ABSTRACT FROM AUTHOR]
- Published
- 2014
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43. Diffuse Tuberculous Cerebritis in Immunocompetent Hosts-An Uncommon Entity.
- Author
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DAS, ANIMESH
- Subjects
TUBERCULOUS meningitis ,CENTRAL nervous system infections - Abstract
Central Nervous System (CNS) tuberculosis is a common disease in developing countries with varied presentation, the most common being tuberculous meningitis. Meningitis, in many cases leads to infection of the underlying cortex resulting in cerebritis, encephalitis or abscess formation. Tuberculous cerebritis has either been described as a focal entity in normal subjects or as a diffuse entity in immunocompromised hosts. We present here two cases of diffuse tuberculous cerebritis in immunocompetent patients. One had presented with left focal seizure with paraparesis while the other presented with non-localising features of raised intracranial pressure. Tubercular Polymerase Chain Reaction (PCR) was positive in Cerebrospinal Fluid (CSF) in the first patient while CSF picture was suggestive of tubercular meningitis in the second making him a possible case of tuberculosis. Both the patients improved significantly on anti-tubercular drugs. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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44. Pediatric Neurotuberculosis: A cases series and review of the literature.
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Jamoussi, Maha, Benrhouma, Hanene, Miladi, Zouhour, Ben Younes, Thouraya, Klaa, Hedia, Rouissi, Aïda, Kraoua, Ichraf, and Ben Youssef, Ilhem
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LITERATURE reviews ,TUBERCULOUS meningitis ,CENTRAL nervous system ,CHILD patients ,SYMPTOMS ,THERAPEUTICS - Abstract
Neurotuberculosis or central nervous system tuberculosis is a form of tuberculous infection that affects any part of the nervous system. Although it is more frequent in adults, pediatric cases have been reported in endemic countries and it is potentially a deadly affection. Therefore, any unusual neurological manifestation in a formerly healthy child, independently of their vaccination status, must bring suspicion of CNS tuberculosis among other diagnoses. We report four cases of pediatric neurotuberculosis with various clinical presentations and outcome and a brief review of the litterature. We conclude that clinical manifestations of pediatric neurotuberculosis are extremely variable and could be misleading. Extra-neurological sites are a key element for diagnosis especially in the pediatric population. A diagnosis and clinical outcome score, especially designed for children might help personalize the therapeutic approach and outcome measures. • Neurotuberculosis is a rare condition both in the adult and pediatric population. • We present four varied case studies of neurotuberculosis in children with different clinical manifestations and outcome. • We have described the diagnostic approach in our clinical cases and emphasized the importance of extra-neurological manifestations in the diagnostic orientation since biological confirmation is not always possible. • This article includes a review of neurotuberculosis in children includingclinical manifestations, imaging, confirmation methods, management and outcome. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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45. Importance of differentiating Mycobaterium bovis in tuberculous meningitis.
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González-Duarte, Alejandra, de León, Alfredo Ponce, and Osornio, José Sifuentes
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- *
MYCOBACTERIUM tuberculosis , *MYCOBACTERIAL diseases , *TUBERCULIN , *HIV infections , *TUBERCULOUS meningitis , *TUBERCULOSIS patients , *BACTERIAL diseases - Abstract
The aim of the article is to describe the principal findings among patients with M.tuberculosis and M. bovis CNS infection. Mycobacterium tuberculosis is one of the most common infectious agents that cause death and neurological sequelae around the world. Most of the complications of CNS TB can be attributed to a delay in the diagnosis. Unfortunately, there are no specific diagnostic tools to support an early diagnosis. Other prognostic factors different from delay in treatment have not been identified. Clinical, radiological and laboratory characteristics were analyzed retrospectively from the medical files of all the patients admitted with the diagnoses of tuberculosis. Of 215 patients admitted with systemic tuberculosis, 64 (30%) had a neurological infection. Positive cultures were found in 54 (84%) cases, 18 (33%) in the CSF and the rest in other fluids or tissues. Adenosin deaminase (ADA) enzyme determination was more sensitive than M. tuberculosis PCR in the CSF for supporting an early diagnosis. In addition to a later clinical stage and treatment lag, positive CSF cultures (P=0.001) and the presence of M. bovis (P=0.020) were prognostic factors for a worse outcome. Neither older age, the presence of tuberculomas versus meningeal enhancement, or HIV co-infection, was associated to a worse prognosis. The isolation of M. bovis subspecies was more common that previously reported, and it was associated to the development of parenchymal lesions (P=0.032) when compared to M. tuberculosis. In this study, positive CSF cultures for M. tuberculosis and further identifying M. bovis species were additional prognostic factors for worse outcome. Positive cultures in systemic fluids other than CSF, even when the patient had no obvious systemic manifestations, and ADA determination in the CSF were noteworthy diagnostic tools for the diagnosis. [ABSTRACT FROM AUTHOR]
- Published
- 2011
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46. Unusual Periventricular Hemorrhage as the Initial Manifestation of Central Nervous System Tuberculosis.
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Liu, Yinglin and Chen, Yanru
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- *
CENTRAL nervous system , *TUBERCULOSIS , *HEMORRHAGE , *TUBERCULOUS meningitis , *INTRAVENTRICULAR hemorrhage , *COMPUTED tomography - Abstract
Intracranial hemorrhage (ICH) is a rare complication of central nervous system (CNS) tuberculosis, and intratuberculoma hemorrhage is even more rare. To the best of our knowledge, periventricular hemorrhage caused by CNS tuberculosis has not yet been reported. In the present report, we have described the peculiar neuroradiological manifestations of periventricular hemorrhage secondary to CNS tuberculosis and discussed the possible mechanisms of intratuberculoma hemorrhage supported by the neuroradiological findings. We have reported the case of a 50-year-old man who had presented with headache. The initial computed tomography (CT) scan had shown periventricular hematoma with intraventricular hemorrhage. Despite conventional treatment of ICH, his headache deteriorated and repeated CT scan revealed expansion of the hematoma. Further investigation demonstrated CNS tuberculosis and tuberculomas lying within the periventricular hematoma. ICH can present as the initial manifestation of CNS tuberculosis, and CNS tuberculosis should be suspected when hemorrhage has occurred at an unusual site or the hematoma has expanded despite conventional treatment. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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47. Large intracranial supratentorial tuberculoma imitating as a malignant lesion: a case report.
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Vyas, Shashin N. and Shekhawat, Jitender
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TUBERCULOMA ,LOSS of consciousness ,TUBERCULOUS meningitis ,INTRACRANIAL tumors ,ETIOLOGY of diseases ,TUBERCULOSIS - Abstract
Background: CNS TB roughly correlates to 1–10% of all intracranial tumors. The spectrum of CNS-TB is wide and can present as tuberculous meningitis, tubercular abscess, tuberculoma, or hypertrophic pachymeningitis. Tuberculomas are usually located at the corticomedullary junction and periventricular region, as expected for hematogenous dissemination. They are mostly infratentorial in children and supratentorial in adults. They may present months to years after infection. Observations: Here we have a 55-year-old female who presented with a history of headaches, sudden loss of consciousness, and seizures. Initial imaging showed a right parietal mass lesion appearing to be malignant on initial imaging which had a significant mass effect and midline shift. The patient was operated on for the same and histopathology showed chronic granulomatous lesion and tissue staining s/o tuberculosis. Lessons: So a diagnostic option for infective etiology should be kept even for an intracranial supratentorial mass lesion. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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48. A study of clinical profile and treatment outcomes in CNS tuberculoma.
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Kumar, E. A. Ashok, Ramya, Srirangam, and Neelamraju, Sai Mounika
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TUBERCULOMA ,TUBERCULOUS meningitis ,TREATMENT effectiveness ,SYMPTOMS ,CENTRAL nervous system ,TUBERCULOSIS - Abstract
Worldwide, around 10 million people fall sick every year because of Tuberculosis (TB). In India, the incidence is 2.69 million cases. Central nervous system Tuberculosis (CNS TB), which is one of the most deadly forms of tuberculosis (TB) mainly manifests as TB Meningitis followed by Tuberculoma, Tubercular abscess and other forms. CNS TB is seen in 5 to 10% of extra-pulmonary TB cases, and accounts for 1% of all TB cases and has the highest mortality. They usually present with symptoms such as headache and seizures. They may have other signs and symptoms based on the size and the location of the lesions. The advent of modern technology such as CT, MRI scans helped to diagnose early. Diagnosis is established by CT/MRI Brain, where a granulomatous lesion with/without perilesional edema is seen. MR Spectroscopy brain is indicated when the diagnosis is doubtful. Presence of lipid peak on MR Spectroscopy is diagnostic of CNS Tuberculomas. Medical management is adequate and there is no role for surgery. A course of ATT for 6 months along with corticosteroids is adequate. Addition of corticosteroids is necessary to reduce the paradoxical response; it also reduces the size of the lesion and perilesional edema. Anti epileptic drugs are not necessary. CNS Tuberculoma is curable if treated properly. [ABSTRACT FROM AUTHOR]
- Published
- 2022
49. 1374. Diagnostic Utility of Whole Body Positron Emission Tomography-Computerized Tomography (PET-CT) in Patients with Suspected Central Nervous System Tuberculosis: A Retrospective, Descriptive Study.
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Ramesh, Venkat, Narreddy, Suneetha, Barigala, Ravikiran, Chennamchetty, Vijay Kumar, Kumar, Sudhir, Rao, Jyotsna, Nanda, Sagarika, and Varahala, Sneha
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POSITRON emission tomography computed tomography ,CENTRAL nervous system ,TUBERCULOUS meningitis ,MYCOBACTERIUM tuberculosis ,TUBERCULOSIS ,LYMPH nodes - Abstract
Background There is difficulty in diagnosing central nervous system (CNS) tuberculosis (TB) in the early stages because features mimic viral and pyogenic meningitis. There is a need to determine alternate methods to diagnose CNS TB. Whole-body PET-CT, used mainly in oncology, has shown promise in the detection of tuberculosis and monitoring response to anti-tuberculous therapy. Utility in CNS TB is unexplored. Methods Retrospective, cohort, single-center study. Patients were included if they fulfilled the following criteria: (1) Probable/possible tuberculous meningitis as per the Lancet Consensus Score; (2) undergone whole-body PET-CT with 18-fluorodeoxyglucose and intravenous contrast; (3) less than one week of anti-tuberculous therapy at the time of PET-CT; (4) clinical response to antituberculous treatment and steroids; (5) no other etiological agent identified. Results We identified 9 patients that fulfilled the above criteria. 5 of these patients were immunosuppressed (4 had advanced AIDS, one patient was on immunosuppressive therapy). We found that 86.4% of patients (7 out of 9) had radiological features suggestive of probable active TB outside the CNS (Figure 1). Of these 7 patients, 5 patients had definite TB (defined as positive Ziehl–Neelsen stain or Gene Xpert MTB/RIF assay or culture for tubercle bacilli) outside the CNS while 2 had histopathological evidence of TB (granulomatous inflammation) (Figure 2). All strains of TB were rifampin sensitive. The sites of isolation of tuberculosis were (Figure 3). (a) Abdominal lymph node in 2 patients (40%); (b) cervical lymph node in 2 patients (40%); (c) sputum in 1 patient (20%). In patients with evidence of disease outside the CNS, the average maximum standardized uptake value (SUV Max) in diverse anatomical locations was 5.75 (range 1.9–11.2). The most frequent manifestation PET-CT manifestation suggestive of TB outside the CNS in decreasing order of frequency was cervical lymphadenopathy (in 55.5% of patients), pleural and pulmonary parenchymal involvement (44.4% in each), followed by mediastinal nodes and abdominal lymph nodes in 33.3% (Figure 4). Conclusion PET-CT is a valuable tool in treatment-naive (less than 1 week of anti-tuberculous therapy) patients with suspected CNS tuberculosis. A large proportion of patients have evidence of TB outside the CNS. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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50. New Intracranial Tuberculoma Research from Bahawal Victoria Hospital Discussed [Multiple Intracranial Tuberculomas In Immunocompetent Patient: An Uncommon Primary Manifestation Of Central Nervous System Tuberculosis (CNS TB)].
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TUBERCULOMA ,CENTRAL nervous system ,TUBERCULOSIS ,GRAM-positive bacterial infections ,MYCOBACTERIAL diseases ,TUBERCULOUS meningitis - Abstract
A recent report discusses research on intracranial tuberculoma, a manifestation of tuberculosis (TB) in the central nervous system. The report focuses on the case of a 50-year-old immunocompetent patient who presented with multiple intracranial tuberculomas without evidence of meningitis. The patient experienced seizures, weakness, headaches, and fever. Diagnostic tests confirmed the presence of tuberculomas, and the patient was started on anti-tubercular therapy with good compliance and no adverse effects. This research provides insights into an uncommon primary manifestation of CNS tuberculosis. [Extracted from the article]
- Published
- 2023
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