Host Directed Therapies for Tuberculous Meningitis

Davis, Angharad; Donovan, Joseph; Bremer, Marise; Toorn, Ronald van; Schoeman, Johan; Dadabhoy, Ariba; Lai, Rachel; Cresswell, Fiona; Boulware, David R.; Wilkinson, Robert J.; Thuong, Nguyen Thuy Thuong; Thwaites, Guy; Bahr, Nathan C

doi:10.12688/wellcomeopenres.16474.2

Cited by 12 publications

(7 citation statements)

References 119 publications

(186 reference statements)

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“…Uncertainty surrounds the mechanism by which corticosteroids offer clinical benefit, but it is possible due to a diminution in intracerebral inflammation. 20 This report describes a fatal case of tuberculous meningitis. Tuberculous meningitis is the most devastating form of extrapulmonary tuberculosis if left untreated.…”

Section: Discussionmentioning

confidence: 98%

Hydrocephalus Caused by Tuberculous Meningitis in an Immunocompetent Young Adult: A Case Report

Pinzon¹,

Veronica²

2023

IMCRJ

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Background: Despite improved medical management, meningeal tuberculosis mortality and other outcomes have changed slightly over time due to a delay in diagnosis and treatment. This study reports a rare case of tuberculous meningitis in an immunocompetent host, calling into question the commonly held belief that tuberculous meningitis is a disease of immunocompromised individuals. Case Presentation: A 26-year-old male with no significant past medical history, tuberculosis, or indications of immunological compromise, was admitted to our hospital with a fever and altered mental status. He was drowsy, febrile (temperature of 38°C), had a heart rate of 110 beats per minute, and showed mild neck stiffness but no meningeal sign. A lumbar puncture on the third day of admission suggested tuberculous meningitis. He was treated for tuberculosis meningitis, and his condition slightly improved. However, the patient's condition suddenly worsened, and a repeat contrast computed tomography (CT) of the brain showed the development of ventriculomegaly and basilar enhancement. Insertion of an emergency ventriculoperitoneal shunt was performed; however, the patient died ten days after hospital admission. Conclusion:We report a fatal case of tuberculous meningitis in an immunocompetent patient. Healthcare practitioners must be trained to identify and diagnose tuberculous meningitis promptly. Early treatment of tuberculous meningitis based on clinical diagnosis and symptoms improves clinical outcomes.

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Section: Discussionmentioning

confidence: 98%

Hydrocephalus Caused by Tuberculous Meningitis in an Immunocompetent Young Adult: A Case Report

Pinzon¹,

Veronica²

2023

IMCRJ

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“…Post-TBM sequelae are mostly due to a dysregulated host immune response. 235 , 236 Therefore, host-directed therapies are the most promising strategy to improve overall survival and long-term clinical outcomes. More data are needed to inform the treatment of childhood TBM.…”

Section: Children and Adolescents Post-tb Diseasementioning

confidence: 99%

Post-TB health and wellbeing

Nightingale

Carlin

Meghji

et al. 2023

int j tuberc lung dis

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TB affects around 10.6 million people each year and there are now around 155 million TB survivors. TB and its treatments can lead to permanently impaired health and wellbeing. In 2019, representatives of TB affected communities attending the ‘1st International Post-Tuberculosis Symposium´ called for the development of clinical guidance on these issues. This clinical statement on post-TB health and wellbeing responds to this call and builds on the work of the symposium, which brought together TB survivors, healthcare professionals and researchers. Our document offers expert opinion and, where possible, evidence-based guidance to aid clinicians in the diagnosis and management of post-TB conditions and research in this field. It covers all aspects of post-TB, including economic, social and psychological wellbeing, post TB lung disease (PTLD), cardiovascular and pericardial disease, neurological disability, effects in adolescents and children, and future research needs.

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“…The interventions tested include higher doses of rifampicin (15-35mg/kg) [3], adding anti-tuberculosis drugs with good brain penetration (e.g. fluoroquinolones, linezolid) [4], or controlling brain inflammation with adjunctive corticosteroids and aspirin [5].…”

Section: Textmentioning

confidence: 99%