Tuberculous Meningitis

Donald, G. F.; Mckendrick, W.; Grose, R. J.

doi:10.1136/jnnp.20.3.198

Cited by 18 publications

(21 citation statements)

References 7 publications

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“…Exudate may form and cause adhesions blocking the flow and reabsorption of the cerebrospinal fluid (CSF). Pressure may build up, leading to hydrocephalus, ischemia and infarction [3,8,12,[14][15][16]. The original pathological studies on which this description is based were performed in 1933 by Rich and McCordock [12].…”

Section: Immunopathogenesis Pathologymentioning

confidence: 99%

Tuberculous Meningitis in Adults: A Review of a Decade of Developments Focusing on Prognostic Factors for Outcome

2012

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Tuberculous meningitis (TBM) is the most severe form of TB. Despite treatment, mortality and long-term disability remain unacceptably high. Prevention, early recognition, diagnosis and treatment are fundamental to improving outcomes. However, an effective vaccine remains elusive, initial symptoms are nonspecific, and sensitive diagnostic tests are not available. There has been progress in our understanding of the immunopathology of TBM, and several factors have been found to be associated with susceptibility to infection, disease progression and clinical outcome. However, these have not yet impacted on treatment. Early treatment initiation and uninterrupted continuation, severity on presentation, seizures, stroke, cranial nerve involvement, cerebrospinal fluid cell count and lactate levels, hyponatreamia and coinfection with HIV are all found to be important prognostic factors for outcome. Pathogen lineage (Beijing genotype) and host genetics (polymorphisms in TLR2, TIRAP and LTA4H genes) can influence susceptibility to TBM. However, these findings have not yet impacted on treatment. Progress in vaccine development, opportunities for better diagnostic tests, novel insights into pathogenesis and an increasing evidence base for improving treatment should impact the current high mortality and morbidity, if translated to global and local guidelines.

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Section: Immunopathogenesis Pathologymentioning

confidence: 99%

Tuberculous Meningitis in Adults: A Review of a Decade of Developments Focusing on Prognostic Factors for Outcome

2012

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“…Tuberculous meningitis (TBM) is the most severe form of the infection, which is usually caused by M. tuberculosis and poses a serious threat to human health worldwide (7). If left untreated, the mortality associated with TBM is almost 100% and delayed treatment may lead to permanent neurological damage (3,8). The conventional 'gold standard' bacteriological methods, namely direct smear and culture isolation, are hardly able to detect M. tuberculosis in the cerebrospinal fluid (CSF) of patients with TBM.…”

Section: Introductionmentioning

confidence: 99%

Identification of Mycobacterium tuberculosis in the cerebrospinal fluid of patients with meningitis using nested PCR

Rios-Sarabia

Hernández-González

González-y-Merchand

et al. 2016

International Journal of Molecular Medicine

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Abstract. Tuberculous meningitis (TBM) is the most severe form of tuberculosis. It is caused by Mycobacterium tubercu losis (M. tuberculosis; MT) and it is very difficult to diagnose. The symptoms are similar to other infectious neurological diseases, such as neurocysticercosis, neuroborreliosis, or herpes viral infection. The aim of this study was to identify tuberculosis (TB) in cases of meningitis with clinical and laboratory evidence suggestive of TBM, and to confirm our findings with molecular tests for TB infection. We recruited patients with neurological symptoms who were examined at the neurology services of Hospitals of Instituto Mexicano del Seguro Social (IMSS) in Mexico City. A total of 144 consecutive patients with suggestive infectious meningitis were initially included; 94 cases of meningitis with clinical and laboratory evidence suggestive of TBM were included, but only 50 of these cases fulfilled the criteria for probable TBM. As the controls, we included 50 cases of meningitis with clinical and laboratory evidence suggestive of non-TBM. Cerebrospinal fluid (CSF) was collected from all 100 patients (cases and controls) and tested for TB by multiplex and nested PCR analyses. Nested PCR detected 0.1 fg of M. tuberculosis DNA. TB infection was confirmed with molecular tests in 49 patients from the 50 cases suggestive of TBM and in 1 of the 50 non-TBM cases. The analysis exhibited a sensitivity of 98.0%, a specificity of 92.0%, a positive predictive value of 88.0% and a negative predictive value of 98.0%. The use CSF for the analyses proved to be effective for the rapid diagnosis of TBM using a developed system of multiplex and nested PCR analyses in patients presenting neurological symptoms.

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“…Suspected active pulmonary TB based on chest X-ray. 4. Acidfast bacilli found in any sample apart from the CSF.…”

Section: Methodsmentioning

confidence: 99%

“…TBM patients were divided into three stages according to the British Research Council neurological criteria: [4] • (Figures 1 and 2). The CSF glucose:protein ratio in TBM was 0.41 (Table 2).…”

Section: Clinical Stagingmentioning

confidence: 99%

Cross sectional study of 39 Cases of Tuberculous Meningitis in North Bihar

Kumar¹,

Goswami²,

Singh³

et al. 2017

Int J Trop Med Public Health

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Background: Tuberculous meningitis (TBM) is the most severe manifestation of extrapulmonary tuberculosis (TB) with a high mortality and morbidity rates. Exact prevalence of central nervous system TB in India is not known, but it accounts for an estimated 1% of all cases of TB, which equates to around 17,000 cases in India in 2014. The aims of the study are: (1) To review the clinical, laboratory, disease staging, and radiological findings of 39 TBM cases at a single center and (2) to present the local epidemiological data from our cases.Methods: A total of 39 patients admitted to our tertiary hospital with symptoms and signs of meningitis were selected and on the basis of adopted criteria labeled as TBM. Clinical profile, disease staging, and cerebrospinal fluid (CSF) findings noted in each patient. Adenosine deaminase (ADA) level in CSF estimated. Cutoff value of ADA kept at or above 10 IU/L for TBM. The comparative study made with 23 patients of pyogenic meningitis. Results:The mean age of patients with tubercular meningitis was 39.07 ± 16.67 years. The symptom duration ranges from 7 to 98 days with a median of 28 days. Clinically, fever was present in 37 (94.8%), headache in 29 (74.3%), and vomiting in 22 (56.4%) patients. Six (15.38%) patients had seizure. On CSF cytological and biochemical analysis, the mean total white blood cell count was 256.74 ± 184.03/cmm, mean protein 182.22 ± 113.12 mg/dl, and mean sugar 52.85 ± 19.3 mg/dl. The CSF glucose:protein ratio in TBM was 0.41. Out of 39 TBM patients, 33 patients were found to be having CSF ADA at or above the cutoff value of 10 IU/L, whereas six had below cutoff value. On comparison between two groups, the CSF-ADA level found to be highly significant (P < 0.001). On cranial computed tomography or magnetic resource imaging, 28.2% of patients had hydrocephalous, 7.6% with tuberculoma, and 5.1% with spinal arachnoiditis. About one-third of patients had evidence of active TB on chest X-ray. Conclusions:Any patient presenting either acutely or chronically with signs and symptoms of meningitis, urgent CSF examination should be done to diagnose TBM on the basis of CSF lymphocytic pleocytosis, decreased glucose, increased protein, and ADA more than 10 IU/L. Due to high mortality and morbidity, early initiation of antitubercular drugs may prevent sequel.

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Tuberculous Meningitis

Cited by 18 publications

References 7 publications

Tuberculous Meningitis in Adults: A Review of a Decade of Developments Focusing on Prognostic Factors for Outcome

Tuberculous Meningitis in Adults: A Review of a Decade of Developments Focusing on Prognostic Factors for Outcome

Identification of Mycobacterium tuberculosis in the cerebrospinal fluid of patients with meningitis using nested PCR

Cross sectional study of 39 Cases of Tuberculous Meningitis in North Bihar

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