Central Nervous System Tuberculosis Subsequent to Dural Grafting

Abstract

Despite modern diagnostic and treatment modalities, tuberculosis (TB) still remains a major worldwide health problem. Resurgence in developed countries is due mainly to infection with the human immunodeficiency virus, immigration from developing and/or underdeveloped countries, transmissions in hospitals and prisons and development of multidrug-resistant strains of TB.1 According to the estimates of World Health Organization, TB accounts for 7-8 million new cases every year and is responsible for 2.9 million deaths worldwide annually. 2Tuberculosis infection is encountered mainly in underdeveloped or developing countries, but increasing infection rate has recently been reported even in developed countries.3 As a developing country, it has been estimated that TB is increasing rather than decreasing since the 1970s in Turkey and is still a serious problem in this country. 4 It has been estimated that neurological involvement of TB infection constitutes approximately 5-15 % of the cases, with a high predominance in children. 5,6 Central nervous system (CNS) involvement including atypical forms have been reported and reviewed extensively in the literature. [7][8][9] The bacteria are transmitted through inhalation of aerosolized droplets and CNS involvement occurs mainly by hematogenous route. Although iatrogenic CNS infections have been reported, such as after lumbar puncture, 10 there has been no report of CNS TB after allogenic dural grafting.This report concerns allogenic dura mater graft-related lumbar and cerebellar TB in a 20-year old male who underwent on operation to correct Chiari type-I malformation in which posterior fossa decompression followed by allograft dural grafting had been performed. As far as we know, this is the first report of CNS TB following the use of allograft dura mater. CASE REPORTA 20-year-old male was referred to the Neurosurgical Department, Cerrahpasa Medical Faculty, Istanbul University, for further diagnosis and treatment. The patient complained of lumbar pain radiating to both lower extremities, which was accompanied by recent headache. Physical examination disclosed nothing abnormal. However, neurological examination revealed lower extremity weakness (1/5) and neck stiffness. Medical history showed that he had an operation to correct a Chiari type-I malformation, in which posterior decompression plus C1 laminectomy and dural grafting with cadaveric allograft was performed six months prior to the admission to us ( Figure 1) PEER REVIEWED LETTERsevere headache and neck pain four months after the surgical intervention. He was evaluated by his primary neurosurgeon and radiological examination at that time disclosed the syrinx had resolved completely and so it was decided to follow the patient clinically. Two months after his last visit, he developed severe

Nationwide tuberculosis outbreak in the USA linked to a bone graft product: an outbreak report

“… 1 , 2 However, Mycobacterium tuberculosis transmission through tissue grafts is rare. Case reports have shown transmission via bone, 3 heart valve, 4 and dura mater 5 grafts. Tuberculosis transmission can occur from donors with undetected tuberculosis disease or latent tuberculosis infection, 1 which is estimated to affect one quarter of the world's population 6 and 5% of the US population.…”