Recurrent Miliary Tuberculosis Secondary to Infected Ventriculoatrial Shunt

Mohan

Journal of Clinical Tuberculosis and Other Mycobacterial Diseas

2016

Miliary tuberculosis (TB), is a fatal form of disseminated TB characterized by tiny tubercles evident on gross pathology similar to innumerable millet seeds in size and appearance. Global HIV/AIDS pandemic and increasing use of immunosuppressive drugs have altered the epidemiology of miliary TB. Keeping in mind its protean manifestations, clinicians should have a low threshold for suspecting miliary TB. Careful physical examination should focus on identifying organ system involvement early, particularly TB meningitis, as this has therapeutic significance. Fundus examination for detecting choroid tubercles can help in early diagnosis as their presence is pathognomonic of miliary TB. Imaging modalities help in recognizing the miliary pattern, define the extent of organ system involvement and facilitate image guided fine-needle aspiration cytology or biopsy from various organ sites. Sputum or BAL fluid examination, pleural, pericardial, peritoneal fluid and cerebrospinal fluid studies, fine needle aspiration cytology or biopsy of the lymph nodes, needle biopsy of the liver, bone marrow aspiration and biopsy, testing of body fluids must be carried out. GeneXpert MTB/RIF, line probe assay, mycobacterial culture and drug-susceptibility testing must be carried out as appropriate and feasible. Treatment of miliary TB should be started at the earliest as this can be life saving. Response to first-line anti-TB drugs is good. Screening and monitoring for complications like acute respiratory distress syndrome (ARDS), adverse drug reactions like drug-induced liver injury, drug-drug interactions, especially in patients co-infected with HIV/AIDS, are warranted. Sparse data are available from randomized controlled trials regarding optimum regimen and duration of anti-TB treatment.

Section: Clinical Presentationmentioning

confidence: 99%

Miliary tuberculosis: A new look at an old foe

Mohan

Journal of Clinical Tuberculosis and Other Mycobacterial Diseas

2016

Indian Journal of Neurosurgery

“…A case of caseous granuloma at the peritoneal end of a VP shunt has also been reported. 3 Hence, the prosthesis-induced bacilli transmission and spread have been documented earlier. However, the persistence of bacilli after 1 year of chemotherapy is noteworthy.…”

Section: Discussionmentioning

confidence: 92%

Metastatic Tuberculomas along a Nonfunctioning Ventricular Catheter

Bhople

Kharosekar

Bhide

et al. 2021

Open Forum Infectious Diseases

“…The remainder (24/48 [50%]) occurred either in the postpartum period (n = 20) or following a miscarriage or pregnancy termination (n = 4) ( Supplementary Figure 1 ). Nine of the 24 cases that first occurred during pregnancy (38%) were reported to have worsening of symptoms or relapse of disease following pregnancy loss or delivery [ 35 , 37 , 39 , 46 , 49 , 50 , 53 , 58 , 59 ], 3 of which were reported as due to medication nonadherence or patient lost to follow-up [ 46 , 58 , 59 ].…”

Section: Resultsmentioning

confidence: 99%

Pregnancy-Related Tuberculous Meningitis and Immune Reconstitution Inflammatory Syndrome: A Case Series and Systematic Review

Pastick

Kagimu

Dobbin

et al. 2022

Background Tuberculosis is a leading cause of death among women of reproductive age. However, tuberculous meningitis, the most severe form of extrapulmonary tuberculosis, is rarely discussed in pregnancy despite this being a unique period of immune modulation which may predispose women to active disease. Methods We identified and described cases of tuberculous meningitis among pregnant or postpartum women screened during meningitis clinical trials in Uganda from 2018-2022. We conducted a systematic literature review via PubMED/MEDLINE and EMBASE for all English language publications from 1970 to July 10, 2022, to identify additional cases. Results We identified 8 cases of pregnancy-related tuberculous meningitis in Ugandan women living with HIV and 40 additional cases via systematic literature review (none HIV-positive). Of all combined cases, 50% (24/48) were diagnosed postpartum; 50% (24/48) had initial onset during pregnancy, of which 38% (9/24) had worsening of symptoms or disease relapse following pregnancy cessation. Diagnosis was missed or delayed in 33% (16/48) of cases. For those with known outcomes, maternal mortality was 23% (11/48) and fetal/neonatal mortality was 30% (13/44). Of maternal survivors, 30% (11/37) had residual neurologic deficits. Conclusion The true incidence of tuberculous meningitis in pregnancy or the postpartum period is unclear but likely underappreciated. To date, nearly all published cases have occurred in HIV-negative, or otherwise immunocompetent women. Given the well-described physiological immunosuppression during pregnancy and subsequent reconstitution postpartum, physicians must be aware of tuberculous meningitis and pregnancy-related immune reconstitution inflammatory syndrome, especially in high burden tuberculosis countries and in women living with HIV.