Peripheral neuropathy in persons with tuberculosis

Abstract

Peripheral neuropathy (PN) is a serious condition affecting the nerves that is commonly seen in patients with tuberculosis (TB). Causes of PN in patients with TB are multiple, and can include TB itself, other co-morbid conditions, such as Human Immune-deficiency virus (HIV) disease, malnutrition, or diabetes mellitus (DM), and several anti-tuberculous medications. The condition can manifest with a variety of symptoms, and a diagnosis can usually be made on a clinical basis. Treatment and prognosis of PN vary depending on the underlying cause, but often the condition can lead to permanent disability in individuals with TB. For this reason, primary prevention is key as is early identification and management of symptoms. Treatment can include withdrawal of possible offending agents, vitamin supplementation, physical therapy, analgesics, and targeted agents, including tricyclic antidepressants, selective serotonin reuptake inhibitors, and gabapentin. Additional research is needed to better describe the morbidity and disability associated with PN in persons with TB and to improve management strategies for persons at risk for and affected by this condition. Case review: RM is a 47 year-old man who is in his third month of treatment for drug-resistant TB (DR-TB). His treatment regimen consists of kanamycin (1 gm intramuscular daily), levofloxacin (1000 mg by mouth daily), cycloserine (750 mg by mouth daily), ethionamide (750 mg by mouth daily), pyrazinamide (1500 mg by mouth daily), and Para-Amino Salicylate (12 gm by mouth daily). He is HIV-infected with a CD4 count of 470 cell/µl and on a stable antiretroviral therapy regimen of tenofovir, lamivudine, and efavirenz, which he started 8 weeks ago. He works in a platinum mine, denies smoking, reports drinking beer “on the weekend” and denies other drugs. He presents for his 3 month clinical visit for his DR-TB follow-up and states he is doing well, but he does report some “burning” in the bottom of his feet.

Diagnosing peripheral neuropathy in South‐East Asia: A focus on diabetic neuropathy

“…Tuberculosis (TB) remains a major public health concern in SEA, contributing to 40% of the global burden of disease, and the increasing incidence of HIV increases the risk of TB. TB is associated with PN, and antituberculous drugs, especially isoniazid, can lead to PN 5 . In addition, with drug‐resistant TB, various second‐line treatments, such as cycloserine, ethionamide, fluoroquinolones and newer drugs (such as linezolid), can cause PN (26%) 6 .…”

A Cross Sectional Study of Neuropathy in Patients on Art With Comparison to Patients on Both Art With Att

“…HIV infection itself results in an increased rate of serious adverse events in patients on TB treatment and ART may further increase this. 16 A retrospective cohart study in south Africa patients on rifampicin based TB treatment found increased serious adverse effects, primarily peripheral neuropathy and increased vomiting, in HIV infected compared with uninfected patients. 17 The same result was found in study of HIV associated sensory neuropathy probably because of combined toxicity of both drugs.…”

Bilateral Foot-Drop Secondary to Axonal Neuropathy in a Tuberculosis Patient With Co-Infection of COVID-19: A Case Report

“…It has long been known to cause various extra-pulmonary manifestations and can affect any part of the body, one such rarer manifestation that has been associated with it is peripheral neuropathy. How it affects the peripheral nerves has not been studied in great detail; various mechanisms have been linked to this including direct invasion, immune-mediated phenomenon, vasa vasorum inflammation, and effect of anti-TB medications, but due to the rarity of this condition limited work has been done on this topic [ 2 - 3 ].…”