Predictors of Infarction in Tuberculous Meningitis in Indian Patients

Bhasin, Ashu; Kuthiala, Neha; Sharma, Sakshi; Subramaniyam, Vivekanandhan; Srivastava, Mvp

doi:10.1016/j.jstrokecerebrovasdis.2021.106088

Cited by 3 publications

(2 citation statements)

References 23 publications

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“…Previous studies showed that factors such as older age ( 6 , 11 ), disease severity ( 10 ), peripheral markers of inflammation ( 10 ), and CSF cytokines ( 7 ) are associated with stroke in patients with TBM, suggesting that the host immune status may be related to the development of stroke. The diversity of neuroimaging markers of inflammation is probably the representative of the host immune response in TBM ( 1 ).…”

Section: Discussionmentioning

confidence: 99%

“…There have been several observational studies that have attempted to determine the predictors of stroke in TBM (6)(7)(8)(9)(10)(11), but these were single-center studies with small sample sizes, and the conclusion seemed to vary across studies conducted in different countries (4). Moreover, most stroke mimics and imaging presentations appeared on admission, and the timing of the onset of stroke in TBM was not clear in previous reports (4,12).…”

Section: Introductionmentioning

confidence: 99%

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Acute ischemic stroke in tuberculous meningitis

Guo,

Gan,

Zhang

et al. 2024

Front. Public Health

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BackgroundThe underlying mechanism for stroke in patients with tuberculous meningitis (TBM) remains unclear. This study aimed to investigate the predictors of acute ischemic stroke (AIS) in TBM and whether AIS mediates the relationship between inflammation markers and functional disability.MethodsTBM patients admitted to five hospitals between January 2011 and December 2021 were consecutively observed. Generalized linear mixed model and subgroup analyses were performed to investigate predictors of AIS in patients with and without vascular risk factors (VAFs). Mediation analyses were performed to explore the potential causal chain in which AIS may mediate the relationship between neuroimaging markers of inflammation and 90-day functional outcomes.ResultsA total of 1,353 patients with TBM were included. The percentage rate of AIS within 30 days after admission was 20.4 (95% CI, 18.2–22.6). A multivariate analysis suggested that age ≥35 years (OR = 1.49; 95% CI, 1.06–2.09; P = 0.019), hypertension (OR = 3.56; 95% CI, 2.42–5.24; P < 0.001), diabetes (OR = 1.78; 95% CI, 1.11–2.86; P = 0.016), smoking (OR = 2.88; 95% CI, 1.68–4.95; P < 0.001), definite TBM (OR = 0.19; 95% CI, 0.06–0.42; P < 0.001), disease severity (OR = 2.11; 95% CI, 1.50–2.90; P = 0.056), meningeal enhancement (OR = 1.66; 95% CI, 1.19–2.31; P = 0.002), and hydrocephalus (OR = 2.98; 95% CI, 1.98–4.49; P < 0.001) were associated with AIS. Subgroup analyses indicated that disease severity (P for interaction = 0.003), tuberculoma (P for interaction = 0.008), and meningeal enhancement (P for interaction < 0.001) were significantly different in patients with and without VAFs. Mediation analyses revealed that the proportion of the association between neuroimaging markers of inflammation and functional disability mediated by AIS was 16.98% (95% CI, 7.82–35.12) for meningeal enhancement and 3.39% (95% CI, 1.22–6.91) for hydrocephalus.ConclusionNeuroimaging markers of inflammation were predictors of AIS in TBM patients. AIS mediates < 20% of the association between inflammation and the functional outcome at 90 days. More attention should be paid to clinical therapies targeting inflammation and hydrocephalus to directly improve functional outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Acute ischemic stroke in tuberculous meningitis

Guo,

Gan,

Zhang

et al. 2024

Front. Public Health

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Clinical efficacy of dexamethasone combined with isoniazid in the treatment of tuberculous meningitis and its effect on peripheral blood T cell subsets

Hou,

Wang,

Shi

et al. 2024

Open Medicine

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Objective To investigate the clinical efficacy of dexamethasone (Dex) combined with isoniazid in tuberculous meningitis (TBM) and its effect on peripheral blood T cell subsets. Methods A total of 235 patients with TBM were divided into the control group (117 cases) and the observation group (118 cases). Both groups were given conventional treatment, the control group was further given isoniazid, and the observation group was further given Dex combined with isoniazid. The therapeutic effect and improvement of clinical symptoms were evaluated, peripheral blood T lymphocyte subsets and neurological function were observed, and patients’ prognosis was evaluated. Results The total effective rate of the observation group was higher. The recovery time of cerebrospinal fluid (CSF) pressure, CSF protein content, CSF cell count, and hospital stays in the observation group were shorter. The duration of cervicogenic headache, fever, vomiting, and coma in the observation group was shorter. CD3+ and CD4+/CD8+ proportions in the observation group were higher, and CD8+ proportion was lower. The NIHSS score and MRS score of the observation group were lower, as well as the incidence of adverse reactions. Conclusion Dex combined with isoniazid alleviates clinical symptoms and neurological abnormalities and regulates peripheral blood T cell subsets in TBM.

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Role of IL 6 as a Biomarker in the Diagnosis of Tuberculous Meningitis – A Systematic Review

Kruthika

2022

The International Journal of Mycobacteriology

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Background: Tuberculous meningitis (TBM) is the most common and serious form of central nervous system tuberculosis (TB) with high morbidity and mortality. Following the encounter of tubercle bacilli by microglial cells, inflammatory process sets in and series of cytokines are secreted such as tumor necrosis factor, interleukin-6 (IL6), and interferon γ. The following study was undertaken with the aim of systemically reviewing the diagnostic and prognostic evidence of IL6 in TBM. Methods: After a thorough search of databases for the articles with IL6 association in TBM published from 2001 onwards to September 2021. Articles were identified and assessed according to the inclusion and exclusion criteria. Excel spreadsheets were used for the extraction of data and analysis. Results: A total of 10 studies were included for review which focused on IL6 in the role of TBM diagnosis. All the age group persons of both sexes were included in the study. The experiment was conducted mostly in the developing countries. The range of measured IL6 values was very wide and difficult to interpret. Conclusion: TBM patients' IL 6 was higher than healthy controls in all the studies mentioned, but the results of cerebrospinal fluid IL6 and serum IL6 were less consistent. Due to a small number of prospective studies, it was not possible to analyze the IL6 cut-off value to diagnose TB. Further studies are required to provide information on IL6 as biomarker in the diagnosis of TBM.

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Predictors of Infarction in Tuberculous Meningitis in Indian Patients

Cited by 3 publications

References 23 publications

Acute ischemic stroke in tuberculous meningitis

Acute ischemic stroke in tuberculous meningitis

Clinical efficacy of dexamethasone combined with isoniazid in the treatment of tuberculous meningitis and its effect on peripheral blood T cell subsets

Role of IL 6 as a Biomarker in the Diagnosis of Tuberculous Meningitis – A Systematic Review

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