Brain tuberculomas, tubercular meningitis, and post-tubercular hydrocephalus in children

Chatterjee, Sandip

doi:10.4103/1817-1745.85725

Cited by 65 publications

(67 citation statements)

References 31 publications

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“…Some studies advocate a longer duration of standard four-drug therapy [2]. Most lesions resolve with chemotherapy, but some require surgical intervention.…”

Section: Specific Antituberculous Treatmentmentioning

confidence: 99%

“…The presence of tuberculoma is not prognostic for outcome, but tuberculoma in the frontal, temporal and optochiasmatic regions tend to carry a worse prognosis than tuberculoma elsewhere in the brain [23]. Cranial nerve involvement is common in TBM and occurs in 20-30% of patients [2]. Optochiasmatic arachnoiditis and hydrocephalus on MRI are predictors of the presence of cranial neuropathy, which is associated with poor outcome [24].…”

Section: Imagingmentioning

confidence: 99%

“…The incidence of extra pulmonary TB is directly related to the prevalence of TB infection. CNS TB comprises approximately 10% of all TB cases [2].…”

mentioning

confidence: 99%

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Tuberculous Meningitis in Adults: A Review of a Decade of Developments Focusing on Prognostic Factors for Outcome

2012

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Tuberculous meningitis (TBM) is the most severe form of TB. Despite treatment, mortality and long-term disability remain unacceptably high. Prevention, early recognition, diagnosis and treatment are fundamental to improving outcomes. However, an effective vaccine remains elusive, initial symptoms are nonspecific, and sensitive diagnostic tests are not available. There has been progress in our understanding of the immunopathology of TBM, and several factors have been found to be associated with susceptibility to infection, disease progression and clinical outcome. However, these have not yet impacted on treatment. Early treatment initiation and uninterrupted continuation, severity on presentation, seizures, stroke, cranial nerve involvement, cerebrospinal fluid cell count and lactate levels, hyponatreamia and coinfection with HIV are all found to be important prognostic factors for outcome. Pathogen lineage (Beijing genotype) and host genetics (polymorphisms in TLR2, TIRAP and LTA4H genes) can influence susceptibility to TBM. However, these findings have not yet impacted on treatment. Progress in vaccine development, opportunities for better diagnostic tests, novel insights into pathogenesis and an increasing evidence base for improving treatment should impact the current high mortality and morbidity, if translated to global and local guidelines.

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“…Some studies advocate a longer duration of standard four-drug therapy [2]. Most lesions resolve with chemotherapy, but some require surgical intervention.…”

Section: Specific Antituberculous Treatmentmentioning

confidence: 99%

Section: Imagingmentioning

confidence: 99%

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Tuberculous Meningitis in Adults: A Review of a Decade of Developments Focusing on Prognostic Factors for Outcome

2012

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“…The incidence of TBM is directly related to the prevalence of TB infection and comprises approximately 10% of all TB cases (2). Despite the advent of newer antitubercular agents and imaging techniques, TBM still causes high mortality rates and severe neurologic deficiencies (3,4).…”

mentioning

confidence: 99%

Linezolid Manifests a Rapid and Dramatic Therapeutic Effect for Patients with Life-Threatening Tuberculous Meningitis

Sun

Ruan

Wang

et al. 2014

Antimicrob Agents Chemother

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bWe conducted a retrospective cohort study of patients with MRC grade II/III tuberculous meningitis (TBM) who accepted a background antitubercular regimen (BR) with or without linezolid (LZD). At the 4th week, the LZD-BR group achieved a faster and higher percentage of Glasgow coma scale recovery and temperature recovery, a higher cerebrospinal fluid (CSF)/blood glucose ratio, and lower CSF white blood cell counts than did the BR group. Short-term linezolid supplementation may be a more effective treatment for life-threatening TBM.T uberculous meningitis (TBM) is one of the most common forms of central nervous system (CNS) infections, especially in developing countries, where tuberculosis (TB) is highly epidemic (1). The incidence of TBM is directly related to the prevalence of TB infection and comprises approximately 10% of all TB cases (2). Despite the advent of newer antitubercular agents and imaging techniques, TBM still causes high mortality rates and severe neurologic deficiencies (3, 4).New TB drugs are required to manage patients with TBM who face an increasing threat of drug resistance. A recent study from southwestern China found a rate of 32.14% of multidrug-resistant tuberculosis (MDR-TB) in TBM patients, which is higher than the reported resistances for pulmonary tuberculosis (5). First approved in 2000 for treating drug-resistant Gram-positive bacterial infections (6), linezolid (LZD) has shown antituberculosis potential in recent years. A number of case reports and retrospective studies suggest that linezolid may be effective in treating MDR and extensively drug-resistant tuberculosis (XDR-TB) (7-15). Furthermore, a phase 2a randomized two-group study showed that linezolid was effective at achieving culture conversion among patients with treatment-refractory pulmonary XDR-TB, but patients must be monitored carefully for adverse events (16).Diagnosis and management differ significantly between TBM and pulmonary TB (1, 17). Acid-fast bacilli (AFB) have been found in fewer than 20% of patients with TBM (18), and the culture of cerebrospinal fluid (CSF), although considered the gold standard for diagnosis, is positive in only about 40% of cases (19). For most patients with TBM, pathogenic evidence and drug susceptibility testing (DST) results are not available in the initial phase of treatment when patients present with serious manifestations, such as conscious disturbance, headache, and fever. Thus, CSF parameters (Glasgow coma scale [GCS] scores, and temperature, which are closely related to TBM severity), other than culture, are routinely used to evaluate the therapeutic effect of antitubercular regimens in the initial phase of treatment. Although primarily bacteriostatic, linezolid has been employed successfully for treating CNS infections caused by multiresistant organisms. A case report showed good results with linezolid for the treatment of CNS infections in 10 patients, among whom three were caused by mycobacteria (20). However, the efficacy and adverse effects of linezolid in treating TBM hav...

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“…When there is a sizeable inoculation with inadequate cell-mediated immunity, the parenchymal lesion may develop into a tuberculoma or a tuberculous abscess. 10 In Dastur's excellent review and summary of the tuberculoma series, 260 cases were in the brain and 6 were in the cord. Of the 74 tuberculous paraplegias in this group, 44 were extradural, 4 were subdural, 4 were combined subdural and extradural, and 6 were intramedullary.…”

Section: Discussionmentioning

confidence: 99%

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2017

Surg J

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Brain tuberculomas, tubercular meningitis, and post-tubercular hydrocephalus in children

Cited by 65 publications

References 31 publications

Tuberculous Meningitis in Adults: A Review of a Decade of Developments Focusing on Prognostic Factors for Outcome

Tuberculous Meningitis in Adults: A Review of a Decade of Developments Focusing on Prognostic Factors for Outcome

Linezolid Manifests a Rapid and Dramatic Therapeutic Effect for Patients with Life-Threatening Tuberculous Meningitis

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