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Das S, Ray BK, Nandi M, Mondal G, Paul DK. The Spectrum of Intracranial Arteriopathies and Ischemic Strokes in Pediatric Tubercular Meningitis: A Tricentric Study From Eastern India. Pediatr Neurol 2024; 157:57-69. [PMID: 38878674 DOI: 10.1016/j.pediatrneurol.2024.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 04/11/2024] [Accepted: 04/28/2024] [Indexed: 07/20/2024]
Abstract
INTRODUCTION Addressing the need to uniformly classify arteriopathies among patients with arterial ischemic stroke (AIS) due to tubercular meningitis (TBM), we used the Childhood AIS Standardised Classification and Diagnostic Evaluation (CASCADE) criteria. METHODS This tri-centric prospective study included children aged 0.5-12 years with TBM and AIS. Magnetic resonance angiographies (MRAs) were done during admission and repeated 3 and 12 months after discharge. Arteriopathies were classified according to the primary CASCADE criteria. We used the modified Pediatric Alberta Stroke Programme Early Computed Tomography Score as an ordinal measure of infarct volume. The severity of arteriopathies was graded using the focal cerebral arteriopathy severity score (FCASS). The final outcomes were measured at the 12-month follow-up visit using the Pediatric Stroke Outcome Measure (PSOM). RESULTS Out of 55 patients, 64% had MRA-evidenced arteriopathies and 84% had multiple infarcts. The middle cerebral (46%) and internal carotid arteries (22%) were most commonly affected. The basal ganglia (70%) and the cerebral cortex (61%) were most commonly infarcted. CASCADE categories included 3b (40%), 1d (38%), 2b (16%), 2c (5%), progressive (32%), and stable (44%) arteriopathies. Younger age, hypertrophic pachymeningitis, cortical infarcts, recurrent strokes, progressive arteriopathies, EEG abnormalities, and mortality were significantly higher among patients with MRA-proven arteriopathies. Patients with progressive arteriopathies had a significantly higher prevalence of hypertrophic pachymeningitis, cortical infarcts, and recurrent strokes. FCASS correlated positively with outcomes measured by the Pediatric Stroke Outcome Measure and modified Pediatric Alberta Stroke Programme Early Computed Tomography Score. CONCLUSION The CASCADE classification clarified the arteriopathy patterns, enabling us to correlate them with the characteristics of the infarcts. FCASS is useful to grade the arteriopathy severity and progression in TBM.
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Affiliation(s)
- Suman Das
- Department of Neurology, North Bengal Medical College, Siliguri, West Bengal, India.
| | - Biman Kanti Ray
- Department of Neurology, Bangur Institute of Neurosciences, Kolkata, West Bengal, India
| | - Madhumita Nandi
- Department of Pediatric Medicine, North Bengal Medical College, Siliguri, West Bengal, India
| | - Gobinda Mondal
- Department of Pediatric Medicine, Dr. B C Roy Post Graduate Institute of Pediatric Sciences, Kolkata, West Bengal, India
| | - Dilip Kumar Paul
- Department of Pediatric Medicine, Dr. B C Roy Post Graduate Institute of Pediatric Sciences, Kolkata, West Bengal, India
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Allwood BW, Nightingale R, Agbota G, Auld S, Bisson GP, Byrne A, Dunn R, Evans D, Hoddinott G, Günther G, Islam Z, Johnston JC, Kalyatanda G, Khosa C, Marais S, Makanda G, Mashedi OM, Meghji J, Mitnick C, Mulder C, Nkereuwem E, Nkereuwem O, Ozoh OB, Rachow A, Romanowski K, Seddon JA, Schoeman I, Thienemann F, Walker NF, Wademan DT, Wallis R, van der Zalm MM. Perspectives from the 2 nd International Post-Tuberculosis Symposium: mobilising advocacy and research for improved outcomes. IJTLD OPEN 2024; 1:111-123. [PMID: 38966406 PMCID: PMC11221578 DOI: 10.5588/ijtldopen.23.0619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 01/24/2024] [Indexed: 07/06/2024]
Abstract
In 2020, it was estimated that there were 155 million survivors of TB alive, all at risk of possible post TB disability. The 2nd International Post-Tuberculosis Symposium (Stellenbosch, South Africa) was held to increase global awareness and empower TB-affected communities to play an active role in driving the agenda. We aimed to update knowledge on post-TB life and illness, identify research priorities, build research collaborations and highlight the need to embed lung health outcomes in clinical TB trials and programmatic TB care services. The symposium was a multidisciplinary meeting that included clinicians, researchers, TB survivors, funders and policy makers. Ten academic working groups set their own goals and covered the following thematic areas: 1) patient engagement and perspectives; 2) epidemiology and modelling; 3) pathogenesis of post-TB sequelae; 4) post-TB lung disease; 5) cardiovascular and pulmonary vascular complications; 6) neuromuscular & skeletal complications; 7) paediatric complications; 8) economic-social and psychological (ESP) consequences; 9) prevention, treatment and management; 10) advocacy, policy and stakeholder engagement. The working groups provided important updates for their respective fields, highlighted research priorities, and made progress towards the standardisation and alignment of post-TB outcomes and definitions.
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Affiliation(s)
- B W Allwood
- Division of Pulmonology, Department of Medicine, Faculty of Medicine, Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - R Nightingale
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool
- Department of Respiratory Medicine, Liverpool University Hospitals NHS foundation Trust, Liverpool, UK
| | - G Agbota
- University of Montpellier, Recherches Translationnelles sur le VIH et les Maladies Infectieuses (TransVIHMI), Institut de recherche pour le Developpement (IRD), Institut National de la Sante et de la Recherche Médicale (INSERM), Montpellier, France
- Institut de Recherche Cliniques du Benin (IRCB), Abomey-Calavi, Benin
| | - S Auld
- Departments of Medicine, Epidemiology, and Global Health, Emory University School of Medicine and Rollins School of Public Health, Atlanta, GA
| | - G P Bisson
- Departments of Medicine and Biostatistics, Epidemiology, and Informatics, Division of Infectious Diseases and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - A Byrne
- Thoracic Medicine Division of the Heart Lung Stream of St Vincent's Hospital Sydney Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Socios En Salud Sucursal, Lima, Peru
| | - R Dunn
- Division of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town
| | - D Evans
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
| | - G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - G Günther
- Department of Pulmonary Medicine and Allergology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Z Islam
- Alliance for Public Health, Kyiv, Ukraine
| | - J C Johnston
- University of British Columbia, Vancouver, BC, Canada
| | - G Kalyatanda
- Division of Infectious Disease and Global Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - C Khosa
- Instituto Nacional de Saúde, Marracuene, Mozambique
| | - S Marais
- Division of Neurology, Department of Medicine, University of Cape Town & Neurology Research Group, Neuroscience Institute, University of Cape Town, Cape Town
| | | | - O M Mashedi
- Kenya Medical Research Institute, Centre for Respiratory Diseases Research, Nairobi, Kenya
| | - J Meghji
- National Heart & Lung Institute, Imperial College London, London, UK
| | - C Mitnick
- Program in Infectious Disease and Social Change, Harvard Medical School, Boston, MA, USA
| | - C Mulder
- Division TB Elimination and Health System Innovations, KNCV Tuberculosis Foundation, The Hague, The Netherlands
- Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - E Nkereuwem
- Vaccines and Immunity Theme, MRC (Medical Research Council) Unit The Gambia at The London School of Hygiene & Tropical Medicine, Atlantic Boulevard, Fajara, The Gambia
| | - O Nkereuwem
- Vaccines and Immunity Theme, MRC (Medical Research Council) Unit The Gambia at The London School of Hygiene & Tropical Medicine, Atlantic Boulevard, Fajara, The Gambia
| | - O B Ozoh
- Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria
| | - A Rachow
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany
- German Center for Infection Research (DZIF), Partner Site Munich, Germany
- Unit Global Health, Helmholtz Zentrum München, German Research Center for Environmental Health (HMGU), Neuherberg, Germany
| | - K Romanowski
- University of British Columbia, Vancouver, BC, Canada
| | - J A Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Infectious Disease, Imperial College London, London, UK
| | | | - F Thienemann
- General Medicine & Global Health (GMGH), Department of Medicine & Cape Heart Institute, University of Cape Town, South Africa
- Department of Internal Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - N F Walker
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool
| | - D T Wademan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - R Wallis
- Department of Medicine, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, NJ, USA
| | - M M van der Zalm
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Huff HV, Wilson-Murphy M. Neuroinfectious Diseases in Children: Pathophysiology, Outcomes, and Global Challenges. Pediatr Neurol 2024; 151:53-64. [PMID: 38103523 DOI: 10.1016/j.pediatrneurol.2023.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/22/2023] [Accepted: 09/24/2023] [Indexed: 12/19/2023]
Abstract
Pathogens with affinity for the central nervous system (CNS) in children are diverse in their mechanisms of infecting and attacking the brain. Infections can reach the CNS via hematogenous routes, transneurally thereby avoiding the blood-brain barrier, and across mucosal or skin surfaces. Once transmission occurs, pathogens can wreak havoc both by direct action on host cells and via an intricate interplay between the protective and pathologic actions of the host's immune system. Pathogen prevalence varies depending on region, and susceptibility differs based on epidemiologic factors such as age, immune status, and genetics. In addition, some infectious diseases are monophasic, whereas others may lie dormant for years, thereby causing a dynamic effect on outcomes. Outcomes in survivors are highly variable for each particular pathogen and depend on the vaccination and immune status of the patient as well as the speed by which the patient receives evidence-based treatments. Given pathogens cause communicable diseases that can cause morbidity and mortality on a population level when spread, the burden is often the greatest and the outcomes the worst in low-resource settings. Here we will focus on the most common infections with a propensity to affect a child's brain, the pathologic mechanisms by which they do so, and what is known about the developmental outcomes in children who are affected by these infections.
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Affiliation(s)
- Hanalise V Huff
- Department of Neurology, National Institutes of Health, Bethesda, Maryland
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