Presentations and outcomes of central nervous system TB in a UK cohort: The high burden of neurological morbidity

Logan, Clare; Mullender, Claire; Mirfenderesky, Miriam; Feasey, Nicholas; Cosgrove, Catherine; Riley, Peter; Houston, Angela; Harrison, Thomas S.; Bicanic, Tihana; Rich, Phil; Hart, Paul; Molloy, Síle F.; Macallan, Derek C.

doi:10.1016/j.jinf.2020.10.028

Cited by 14 publications

(10 citation statements)

References 38 publications

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“… 10 , 21 When M. tb infects the central nervous system, CNS-TB mainly manifests as tuberculous meningitis (TBM) and intracranial tuberculous mass lesion (TBML). 22 The infection site is different, which makes the clinical manifestation lack specificity. When the basal meninges are involved, it will cause local vasculitis and lead to cranial nerve injury, patients have focal neurological dysfunction and cerebral parenchyma ischemia symptoms; when cerebrospinal fluid is blocked by tuberculous brain abscess, patients not only have typical clinical symptoms of increased intracranial pressure, but it also leads to the formation of hydrocephalus.…”

Section: Discussionmentioning

confidence: 99%

Bioinformation Analysis Reveals IFIT1 as Potential Biomarkers in Central Nervous System Tuberculosis

Qiao¹,

Fan²,

Shang³

et al. 2022

IDR

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Central nervous system tuberculosis is the most serious form of extrapulmonary tuberculosis. We aim to discover potential biomarkers involved in the development of the disease. Methods: Through gene difference analysis, construction of a protein interaction network and tissue specific analysis and other bioinformatics analysis methods, we found out the relatively high expression of important substances in the central nervous system, interferon induced protein with tetratricopeptide repeats 1. Subsequently, the lesion tissue and the resection margin tissue away from the lesion were collected from the 6 cases of central nervous system tuberculosis patients diagnosed from 2019 to 2020, and the pathological manifestations were observed by Hematoxylin and Eosin (H&E) staining, and the expression of IFIT1 was verified by immunohistochemistry. Results: A total of 101 differential genes were analyzed between extrapulmonary tuberculosis patients and normal people, and they were mainly enriched in the interferon pathway. The protein interaction network unearthed 34 key genes. Through tissue specific analysis, it was found that IFIT1 is relatively high in the central nervous system. H&E staining showed the expression of multinucleated macrophages, and immunohistochemistry showed that IFIT1 was significantly positively expressed in the lesion tissue. Conclusion: IFIT1 is an important substance involved in central nervous system tuberculosis.

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Section: Discussionmentioning

confidence: 99%

Bioinformation Analysis Reveals IFIT1 as Potential Biomarkers in Central Nervous System Tuberculosis

Qiao¹,

Fan²,

Shang³

et al. 2022

IDR

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“…In addition to physical disability, neurocognitive impairment occurs in 10% to 55% of adult survivors, and approximately half of child survivors have long-term neurodevelopmental consequences 53 . Risk factors for death include advanced MRC disease stage, hydrocephalus, altered consciousness, older age, HIV co-infection, low CSF white blood cell count, positive CSF culture, and infarct 7,52,54 . Several bedside prediction scores have been developed to identify individuals at the highest risk of mortality to target them for more aggressive clinical management, but these have not yet been validated in more diverse populations 55,56 …”

Section: Discussionmentioning

confidence: 99%

“…7 However, outcomes vary widely with mortality rates as high as 60% in lower-resource settings and less than 20% in higher-resource settings with greater access to critical care facilities. 51,52 In addition to physical disability, neurocognitive impairment occurs in 10% to 55% of adult survivors, and approximately half of child survivors have long-term neurodevelopmental consequences. 53 Risk factors for death include advanced MRC disease stage, hydrocephalus, altered consciousness, older age, HIV co-infection, low CSF white blood cell count, positive CSF culture, and infarct.…”

Section: Treatmentmentioning

confidence: 99%

Neurologic Complications of Tuberculosis

Saylor¹

2021

CONTINUUM: Lifelong Learning in Neurology

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PURPOSE OF REVIEW: This article describes the current epidemiology, common clinical characteristics, and up-to-date evidence-based approaches to the diagnosis and management of the most common neurologic complications of tuberculosis (TB): tuberculous meningitis, intracranial tuberculoma, and spinal TB.RECENT FINDINGS: Central nervous system (CNS) TB remains common and associated with significant mortality and neurologic sequelae worldwide. Human immunodeficiency virus (HIV) co-infection is strongly associated with both the development of and mortality due to CNS TB. Strongyloides co-infection is associated with reduced CNS inflammation and improved outcomes in the setting of tuberculous meningitis. Stroke remains a common complication of tuberculous meningitis, and emerging evidence suggests aspirin may be used in this context. Although a recent nucleic acid amplification test has demonstrated suboptimal sensitivity in the diagnosis of CNS TB, emerging diagnostic techniques include cell-free DNA, peripheral blood microRNA, metagenomic next-generation sequencing, and advanced imaging techniques, but these are not yet well validated. CNS TB is associated with high mortality even with current treatment regimens, although novel, promising strategies for treatment are under investigation, including a combination of IV isoniazid and ethambutol and high-dose rifampicin.SUMMARY: TB can affect the nervous system in various ways and is associated with high mortality. Diagnosis remains challenging in endemic settings, with empiric treatment often initiated without a definitive diagnosis. Furthermore, optimal treatment regimens remain uncertain because current treatment for all forms of CNS TB is extrapolated from trials of tuberculous meningitis whereas the role of steroids in people with HIV and tuberculous meningitis remains controversial.

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“…The social and economic impacts on individuals thus affected by the disease are profound even following a reported recovery. A study in the UK focusing on tuberculous meningitis in adults found that over one-third of survivors had residual neurological sequelae one year later [ 5 ].…”

Section: Neurological Disability Quality Of Life and Access To Carementioning

confidence: 99%

“…Prior to the advent of widespread vaccination campaigns, bacterial meningitis outbreaks imparted a significant toll, with some pathogens, such as group A Neisseria meningitidis , having meningitis rates as high as 1% of the population during major African epidemics in the last century [ 2 ]. Tuberculosis, which affects millions of people each year worldwide, predominantly in low- and middle-income countries (LMICs) [ 3 ] affects the central nervous system in approximately 1% of cases [ 4 ] yet can also result in profound mortality and morbidity [ 5 ]. Multiple factors contribute to the impact or severity of different pathogens causing meningitis.…”

Section: Introductionmentioning

confidence: 99%

The Impact and Burden of Neurological Sequelae Following Bacterial Meningitis: A Narrative Review

2021

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The burden, impact, and social and economic costs of neurological sequelae following meningitis can be devastating to patients, families and communities. An acute inflammation of the brain and spinal cord, meningitis results in high mortality rates, with over 2.5 million new cases of bacterial meningitis and over 236,000 deaths worldwide in 2019 alone. Up to 30% of survivors have some type of neurological or neuro-behavioural sequelae. These include seizures, hearing and vision loss, cognitive impairment, neuromotor disability and memory or behaviour changes. Few studies have documented the long-term (greater than five years) consequences or have parsed out whether the age at time of meningitis contributes to poor outcome. Knowledge of the socioeconomic impact and demand for medical follow-up services among these patients and their caregivers is also lacking, especially in low- and middle-income countries (LMICs). Within resource-limited settings, the costs incurred by patients and their families can be very high. This review summarises the available evidence to better understand the impact and burden of the neurological sequelae and disabling consequences of bacterial meningitis, with particular focus on identifying existing gaps in LMICs.

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Presentations and outcomes of central nervous system TB in a UK cohort: The high burden of neurological morbidity

Cited by 14 publications

References 38 publications

Bioinformation Analysis Reveals IFIT1 as Potential Biomarkers in Central Nervous System Tuberculosis

Bioinformation Analysis Reveals IFIT1 as Potential Biomarkers in Central Nervous System Tuberculosis

Neurologic Complications of Tuberculosis

The Impact and Burden of Neurological Sequelae Following Bacterial Meningitis: A Narrative Review

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