Twenty Years of Pediatric Tuberculous Meningitis: A Retrospective Cohort Study in the Western Cape of South Africa

Well, Gijs Th. J. van; Paes, Bosco; Terwee, Caroline B.; Springer, Priscilla; Roord, John J.; Donald, Peter R.; Furth, A. Marceline van; Schoeman, Johan

doi:10.1542/peds.2008-1353

Cited by 248 publications

(266 citation statements)

References 23 publications

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“…Invasion of Mycobacterium tuberculosis , the causative agent of TB, into the central nervous system (CNS) occurs in 1% of all cases (Thwaites, van Toorn, & Schoeman, 2013; Wilkinson et al, 2017). Major risk groups for developing TBM include young children and HIV‐positive individuals in TB endemic areas (van Well et al, 2009; Wilkinson et al, 2017). Despite extensive research efforts, the diagnosis and treatment of TBM is often delayed because of its insidious onset (Wilkinson et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

Mycobacteria employ two different mechanisms to cross the blood-brain barrier

Leeuwen

Boot

Kuijl

et al. 2018

Cellular Microbiology

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Central nervous system (CNS) infection by Mycobacterium tuberculosis is one of the most devastating complications of tuberculosis, in particular in early childhood. In order to induce CNS infection, M. tuberculosis needs to cross specialised barriers protecting the brain. How M. tuberculosis crosses the blood–brain barrier (BBB) and enters the CNS is not well understood. Here, we use transparent zebrafish larvae and the closely related pathogen Mycobacterium marinum to answer this question. We show that in the early stages of development, mycobacteria rapidly infect brain tissue, either as free mycobacteria or within circulating macrophages. After the formation of a functionally intact BBB, the infiltration of brain tissue by infected macrophages is delayed, but not blocked, suggesting that crossing the BBB via phagocytic cells is one of the mechanisms used by mycobacteria to invade the CNS. Interestingly, depletion of phagocytic cells did not prevent M. marinum from infecting the brain tissue, indicating that free mycobacteria can independently cause brain infection. Detailed analysis showed that mycobacteria are able to cause vasculitis by extracellular outgrowth in the smaller blood vessels and by infecting endothelial cells. Importantly, we could show that this second mechanism is an active process that depends on an intact ESX‐1 secretion system, which extends the role of ESX‐1 secretion beyond the macrophage infection cycle.

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Section: Introductionmentioning

confidence: 99%

Mycobacteria employ two different mechanisms to cross the blood-brain barrier

Leeuwen

Boot

Kuijl

et al. 2018

Cellular Microbiology

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“…CNS tuberculosis is the most lethal form of tuberculosis and its mortality is around 100% in untreated cases (1,9,10). TB meningitis usually occurs after primary infection in children; however, in adults it is reactivation of old tuberculous foci (2).…”

Section: Discussionmentioning

confidence: 99%

“…Meanwhile its major complication is cerebral infarction and disability (9,12). To diagnose TBM, clinical presentation, imaging, and laboratory data are essential (8).…”

Section: Discussionmentioning

confidence: 99%

Serial Polymorphonuclear Predominance of Cerebrospinal Fluid in a Child with Advanced Tuberculous Meningitis: A Case Report

Hosamirudsari

Afsari

Etesam

2017

Iran Red Crescent Med J

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Introduction: Tuberculous meningitis (TBM) is the most fatal form of tuberculosis. Despite adequate treatment, its mortality and morbidity is high. Clinical, laboratory, and radiologic findings help in diagnosis of TBM, although analysis of cerebrospinal fluid (CFS) might sometimes delay and mislead the rapid diagnosis. Case Presentation: We present a 14-year-old Afghan immigrant male, with uncommon laboratory results of advanced TBM, who referred to Baharloo hospial in Tehran, Iran, in September 2016. He experienced headache and anxiety one month prior to referring to the hospital; he had fever, severe headache, vomiting and showed bizarre behavior 7 days before admission. Suspecting meningoencephalitis, the physician advised empirical treatment. The first CSF revealed polymorphonuclear (PMN) predominance with low glucose, which was repeated in the second and third CSF analysis. This pattern indicates early phase of TB meningitis. In day 4, antituberculous treatment with corticosteroid was administered empirically. Unfortunately, he succumbed to disease in day 36. Polymerase chain reaction (PCR) for mycobacterium tuberculosis (MTB) in CSF was positive. The patient's presentation (lethargic to coma) and brain computed tomography (CT) scan indicated advanced stage of disease. Conclusions: All physicians should consider TB meningitis in any patient with low glucose even with serial PMN predominance in CSF.

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“…(14,15) Another study in African children showed that headache, convulsion, motor function, brainstem dysfunction, and cerebral infarction were independently associated with poor outcomes of TBM. (16) A recent study has demonstrated that seizures associated with tuberculomas most often resolve after successful treatment of the underlying CNS tuberculosis. (17) In this study, several clinical manifestations such as decreased consciousness, fever, headache, spasticity and hemiparesis had no signification correlation with EEG pattern.…”

Section: Discussionmentioning

confidence: 99%

Seizure increases electroencephalographic abnormalities in children with tuberculous meningitis

Gunawan

Saharso

2016

UnivMed

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BACKGROUNDTuberculous meningitis (TBM) is a severe intracranial infection with fatal outcomes, permanent disabilities, and electroencephalographic (EEG) abnormalities. Seizures may occur in TBM. The EEG findings in TBM vary according to the site of the inflammatory process. There are few studies describing the EEG patterns and clinical manifestations of TBM. The objective of this study was to investigate the correlation between clinical findings and EEG patterns in children with TBM.

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Twenty Years of Pediatric Tuberculous Meningitis: A Retrospective Cohort Study in the Western Cape of South Africa

Abstract: Tuberculous meningitis starts with nonspecific symptoms and is often only diagnosed when brain damage has already occurred. Earlier diagnosis will improve outcome significantly. We were able to identify presenting variables independently associated with poor clinical outcome.

Cited by 248 publications

References 23 publications

Mycobacteria employ two different mechanisms to cross the blood-brain barrier

Mycobacteria employ two different mechanisms to cross the blood-brain barrier

Serial Polymorphonuclear Predominance of Cerebrospinal Fluid in a Child with Advanced Tuberculous Meningitis: A Case Report

Seizure increases electroencephalographic abnormalities in children with tuberculous meningitis

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