Tuberculosis Meningitis

Bourgi, Kassem; Fiske, Christina T.; Sterling, Timothy R.

doi:10.1007/s11908-017-0595-4

Cited by 46 publications

(39 citation statements)

References 152 publications

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“…97 Survival benefits have been demonstrated for TB meningitis, 98 although other clinical forms of TB have not shown a consistent benefit from adjunctive corticosteroid treatment. 99 …”

Section: Tb Immunotherapeutic Targets Glucocorticoidsmentioning

confidence: 99%

Tuberculosis: progress and advances in development of new drugs, treatment regimens, and host-directed therapies

Tiberi

Plessis

Walzl

et al. 2018

The Lancet Infectious Diseases

308

275

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Tuberculosis (TB) remains the top killer from an infectious globally causing an estimated 1.674.000 million deaths worldwide. In 2016, WHO estimates 600.000 cases of rifampicin-resistant TB of which 490.000 had multidrug-resistant (MDR) and less than half of them survive after receiving currently recommended WHO treatment regimens, illustrating weaknesses in current treatment approaches. We review progress and advances in the development of new and repurposed TB drugs, treatment trials and host-directed therapies. Updates are provided on phase 3 trials of the new compounds bedaquiline, delamanid, pretomanid; phase 2 trials of sutezolid, SQ-109, LCB01-0371, PBTZ-169; and five new drugs in phase 1 development. Approved or repurposed drugs undergoing further testing are rifampicin, rifapentine, clofazimine, and linezolid. Update on ongoing clinical trials, which aim to shorten TB treatment and improve treatment outcome is given. Several new or repurposed antimicrobial drugs are in advanced trial stages for MDR-TB, and five antimicrobial drug candidates are in phase 1 (Q203, TBI-166, OPC-167832, GSK 070, TBA-7371) and 5 in pre-clinical studies. Specific issues of safety and toxicity; drug-drug interactions; Therapeutic Drug Monitoring are reviewed. A wide range of candidate host-directed therapies (HDTs) and immune-based treatments are being investigated to accelerate the eradication of M.tb infection and for use as adjunctive therapy in shortening duration of treatment, preventing permanent lung injury and improving treatment outcomes of MDR-TB. Ongoing clinical trials of HDTs for TB treatment, the current HDT development pipeline and translational research efforts for advancing further HDT options are presented. Ongoing clinical trials of HDTs for TB treatment, the current HDT development pipeline and translational research efforts for advancing further HDT options are presented.5

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“…97 Survival benefits have been demonstrated for TB meningitis, 98 although other clinical forms of TB have not shown a consistent benefit from adjunctive corticosteroid treatment. 99 …”

Section: Tb Immunotherapeutic Targets Glucocorticoidsmentioning

confidence: 99%

Tuberculosis: progress and advances in development of new drugs, treatment regimens, and host-directed therapies

Tiberi

Plessis

Walzl

et al. 2018

The Lancet Infectious Diseases

308

275

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“…The diagnosis for TBM is clinically challenging and TBM treatment is difficult due to the poor blood–brain barrier penetrance of anti-TB medications [2]. The disease is associated with high mortality even in developed countries [3–5]. Despite the availability of advanced health care, more than 50% of TBM patients may have neurological sequelae and complications or die.…”

Section: Introductionmentioning

confidence: 99%

Trends of tuberculosis meningitis and associated mortality in Texas, 2010-2017, a large population-based analysis

Nguyen

Agarwal

Graviss³

2019

PLoS ONE

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Background As the most severe form of tuberculosis (TB), TB meningitis (TBM) is still associated with high mortality even in developed countries. In certain areas of the United States (U.S.), more than 50% of the TBM patients die with TB or have neurological sequelae and complications despite the availability of advanced health care. This population-based analysis aimed to determine the risk factors and trends associated with TBM morbidity and mortality using state-wide surveillance data. Methods De-identified surveillance data of all confirmed TB patients from the state of Texas between 01/2010 and 12/2017 reported to the National TB Surveillance System was analyzed. Spatial distribution of TBM cases was presented by Stata's Geographic Information Systems mapping. Univariate and multiple generalized linear modeling were used to identify risk factors associated with meningitis morbidity and mortality. Non-parametric testing was used to analyze morbidity and mortality trends. Results Among 10,103 TB patients reported in Texas between 2010 and 2017, 192 (1.9%) had TBM. During this 8-year period, the TBM proportion fluctuated between 1.5% and 2.7% with peaks in 2011 (2.7%) and 2016 (2.1%) and an overall non-significant trend (z = -1.32, p = 0.19). TBM had a higher mortality at diagnosis (8.9%), during treatment (14.1%) and overall (22.9%) compared to non-TBM (1.9%, 5.3%, and 7.2%, respectively, p<0.001). While mortality during treatment was unchanged over time in non-TBM patients (z = 0.5, p = 0.62), it consistently increased in TBM patients after 2013 (z = 3.09, p = 0.002). TBM patients had nearly five times the risk for overall death in multivariate analysis [aRR 4.91 (95% CI 3.71, 6.51), p<0.001]. TBM patients were younger, and more likely to present with miliary TB or HIV (+). Age ≥45 years, resident of a long-term care facility, IDU, diabetes, chronic kidney disease, abnormal chest radiography, positive AFB smear or culture and HIV (+) were independently associated with higher mortality. Conclusion TBM remains challenging in Texas with significantly high mortality. Risk factors determined by multivariate modeling will inform health professionals and lay a foundation for the development of more effective strategies for TBM prevention and management.

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“…In addition to facilitating a discussion on the proper methods for TB screening, our case mortality highlights the recommendations expressed in the literature that empiric antituberculous therapy should not be delayed in patients with a strong clinical suspicion for TB (e.g., previous exposure and basilar meningitis on imaging) coupled with CSF findings of low glucose concentration, elevated protein, and lymphocytic pleocytosis (1,7,8). Because confirmatory TB testing may be difficult to obtain, early and empiric treatment, when there is concern for CNS TB, may result in improved outcomes for patients.…”

Section: Discussionmentioning

confidence: 93%

A Critically Ill Patient With Central Nervous System Tuberculosis and Negative Initial Workup

et al. 2020

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Empiric anti-tuberculous therapy should not be delayed in patients with a strong clinical suspicion for TB. Because confirmatory TB testing may be difficult to obtain, early and empiric treatment, when there is concern for central nervous system TB, may result in improved outcomes for patients. GeneXpert is currently an area of active research, and the test returns diagnostic results within hours, which would make it the preferred test for investigating TB meningitis.

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Tuberculosis Meningitis

Cited by 46 publications

References 152 publications

Tuberculosis: progress and advances in development of new drugs, treatment regimens, and host-directed therapies

Tuberculosis: progress and advances in development of new drugs, treatment regimens, and host-directed therapies

Trends of tuberculosis meningitis and associated mortality in Texas, 2010-2017, a large population-based analysis

A Critically Ill Patient With Central Nervous System Tuberculosis and Negative Initial Workup

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