Advances in the Diagnosis and Management of Tubercular Meningitis in Children
AbstractTubercular meningitis (TBM) continues to be a common cause of neuromorbidity in children. There is no single diagnostic method that can rapidly detectMycobacterium tuberculosis (M.tb) in TBM patients with high sensitivity and specificity. Newer diagnostic modalities like Xpert/RIF assay and Loop mediated isothermal amplification assay (LAMP) have gained an essential stand in molecular diagnostics due to their high specificity, modest sensitivity in cerebrospinal fluid (CSF) and quick availability of results. Intensified drug regimens using high dose rifampicin, fluoroquinolone an d aspirin appear to be useful adjunct therapy but more pediatric clinical trials on large scale are needed to determine their appropriate place in pediatric TBM. The emergence of multi and extreme drug resistantM.tb strains further challenges the standard therapy. In this review authors summarize challenges of the currently used diagnostic methods and treatment for TBM and discuss the recent advances.
Tuberculous meningitis (TBM) is the most devastating form of extrapulmonary Mycobacterium tuberculosis infection in humans. Severe inflammation and extensive tissue damage drive the morbidity and mortality of this manifestation of tuberculosis (TB). Antibiotic treatment is ineffective at curing TBM due to variable and incomplete drug penetration across the blood-brain barrier (BBB) and blood-cerebrospinal fluid (CSF) barriers. Adjunctive corticosteroid therapy, used to dampen the inflammation, and the pathologic manifestation of TBM, improves overall survival but does not entirely prevent the morbidity of the disease and h...
ConclusionIn contrast to tuberculous meningitis, the treatment for CNS tuberculomas appears to require a prolonged administration of corticosteroids. These findings need to be verified in controlled clinical studies.
Publication date: Available online 31 December 2019Source: Multiple Sclerosis and Related DisordersAuthor(s): Bonaventure Ip, Crystal Lam, Vincent Ip, Anne Chan, Vincent Mok, Elaine Au, Eric Chan, Alexander LauAbstractAutoimmune encephalitis is an important group of disease that can mimic infectious encephalitis, with one of the most severe forms being meningoencephalomyelitis. One of the recently identified biomarkers, glial fibillary acidic protein (GFAP), targets the cytosolic intermediate filament protein of astrocytes and causes a variety of clinical symptoms. Here, we report an adult Chinese woman presented with acut...
In this study we analysed the clinical profile of meningoencephalitis and its clinical outcome. METHODS: Fifty adults diagnosed with meningoencephalitis from July 2014 to July 2015 in a tertiary care hospital in South India were studied prospectively and their clinical presentation, aetiology and outcome were analysed. RESULTS: Among 50 patients, 33 (66%) were male; 39 (78%) were
ConclusionsIn conclusion, majority of TBM pediatric patients in RSUD Teluk Bintuni develop hydrocephalus and tuberculoma. The present of hydrocephalus and tuberculoma in these cases showed the severity of their conditions in which resulted in poor outcome. The capability for early diagnosis, or even prevention aspect in Regional Public Hospital Teluk Bintuni pediatric TBM patient is a very important factors that might affect the outcomes.
To study the role of 18FDG- PET (Flourodeoxyglucose positron emission tomography) in a) determining the extent of cranial and extra-cranial disease and b) diagnosis as well as prognosis of CNS TB (central nervous system tuberculosis) including TBM (tuberculous meningitis).
Background: Tuberculosis is a global public health problem. Immunodepression is considered as a risk factor for developing tuberculosis. Immunocompromised patients with tuberculosis have different manifestations and outcome.Aim: Assess the prevalence of tuberculosis in immunocompromised (ID) patients and study its particularities.Methods: A cross sectional comparative study that included patients with tuberculosis followed in the pulmonology department C of Abderrahmen Mami hospital in Tunisia for a period of 7 years (between 2010 and 2017). They were divided into two groups : immunocompetent and immunocompromised.Results:...
Conclusion: PSQ helps detecting MTB complex directly fromCSF even with negative Xpert. Early diagnosis, detection of resistance aids in administering appropriate treatment early and decrease mortality, long term disability. PSQ shows promising results in diagnosing, early detection of resistance in CNS TB. Though correlation with phenotypic DST recommended &further research warranted.
Conclusions: The MPT64 test is better than routine tests for diagnosing EPTB. It performs well irrespective of HIV status.
We describe 2 cases of miliary tuberculosis in young children with clinically unexpected central nervous system involvement. Magnetic resonance imaging of the brain should be considered part of the initial diagnostic workup for miliary tuberculosis in very young children.