Preliminary report of directly observed treatment, short course in tuberculous meningitis

Abstract

Background:Diagnosis of tuberculous meningitis (TBM) is a challenge because of the manifold clinical presentation, and diagnosis is often delayed.Objectives:We wanted to share our experience of directly observed treatment short course (DOTS) in TBM. We did a retrospective analysis to look at the presentation, management and outcome of TBM patients from November 2006 to April 2008.Materials and Methods:TBM was diagnosed based on clinical criteria. We excluded patients with HIV.Results:We had 11 patients on DOTS regime. One died following hepatitis and another patient died of unrelated gastroenteritis. The only patient on daily regime died. Our patients generally presented late, at a median duration 20 days from onset of symptoms, and 50% had stage 3 disease at presentation. The median delay in diagnosis was 4.5 days.Discussion:We found DOTS to be effective in TBM but not without side effects.

Predictors of mortality in patients with meningeal tuberculosis

“…Our preliminary experience with intermittent short-course ATT showed similar in-hospital mortality. [9] Patients who died on RNTCP regimen got five days median treatment compared to three days median treatment with daily regimen (P<0.005). The median duration of illness prior to hospitalization between the patients who died (15 days) and patients who were alive (14 days) was significantly different (P<0.0001).…”

Cystic Mesenteric Inflammatory Pseudotumor Associated to Multidrug-Resistant Meningeal Tuberculosis and a Cerebrospinal Fluid Shunt: An Unusual Case

“…Only 30% of patients with brain TB have a positive chest radiograph [4][5][6][7][8]. Absence of features of TB on chest X-rays should therefore not rule out the possible existence of brain TB [4][5][6][7][8][9]. Tuberculous meningitis (TBM) and tuberculoma (TBC) are the two most important manifestations of CNS TB.…”

“…Intracranial tuberculoma may be solitary or multiple [1][2][3][4]. Solitary tuberculoma may be indistinguishable from cranial abscess or primary brain tumor [8]. Intracranial TBC might be difficult to diagnose when the patient has no evidence or history of tuberculous infection [4].…”

“…Intracranial TBC might be difficult to diagnose when the patient has no evidence or history of tuberculous infection [4]. Inflammatory pseudotumor (IP) was described as a wide range of neoplastic and reactive lesions such as inflammatory myofibroblastic tumor [4][5][6][7][8], and these tumors suggest a chronic inflammatory condition [9][10][11].…”

“…Retroperitoneal mass is an extremely rare manifestation of extrathoracic TB. Abdominal TB collectively refers to gastrointestinal, splenic, pancreatic, hepatobiliary and abdominal lymph node involvement [8,12]. Diagnosis of abdominal pseudotumor is often delayed which can produce serious complications [8].…”