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Chen X, Wei J, Zhang M, Su B, Ren M, Cai M, Zhang Y, Zhang T. Prevalence, incidence, and case fatality of tuberculous meningitis in adults living with HIV: a systematic review and meta-analysis. BMC Public Health 2024; 24:2145. [PMID: 39112980 PMCID: PMC11308199 DOI: 10.1186/s12889-024-19683-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 08/02/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Tuberculous meningitis (TBM) emerges as a grave complication of tuberculosis in people living with HIV (PLWH). The diagnosis and treatment of TBM pose significant challenges, leading to elevated mortality rates. To comprehensively grasp the epidemiological landscape of TBM in PLWH, a systematic review and meta-analysis were meticulously undertaken. METHODS We performed a comprehensive search in PubMed, Embase, and Web of Science from database inception to September 19th, 2023, with no limitations on the publication type. The search terms were HIV/AIDS terms (AIDS OR HIV OR PLWH) and TBM-related terms (tuberculous meningitis OR TBM). Studies included in this meta-analysis evaluated the incidence of TBM among PLWH, or we were able to calculate the incidence of TBM among PLWH from the research. RESULTS The analysis revealed that the prevalence of TBM among PLWH was 13.6% (95% CI: 6.6-25.9%), with an incidence rate of 1.5 cases per 1000 persons per year. The case fatality rate was found to be 38.1% (95% CI: 24.3-54.1%). No significant publication bias was observed. Meta-regression analysis identified the proportion of females and finance situation as factors influencing the outcomes. CONCLUSIONS Our study highlights TBM as a prevalent opportunistic infection that targets the central nervous system in PLWH. The elevated case fatality rate is especially prominent among PLWH in impoverished regions, underscores the pressing necessity for enhanced management strategies for PLWH suffering from TBM. TRIAL REGISTRATION PROSPERO; No: CRD42022338586.
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Affiliation(s)
- Xue Chen
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Beijing Key Laboratory for HIV/AIDS Research, Capital Medical University, Beijing, 100069, China
- Beijing Youan Hospital, Beijing Institute of Hepatology, Capital Medical University, Beijing, 100069, China
| | - Jiaqi Wei
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Beijing Key Laboratory for HIV/AIDS Research, Capital Medical University, Beijing, 100069, China
| | - Mei Zhang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Beijing Key Laboratory for HIV/AIDS Research, Capital Medical University, Beijing, 100069, China
| | - Bin Su
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Beijing Key Laboratory for HIV/AIDS Research, Capital Medical University, Beijing, 100069, China
| | - Meixin Ren
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Beijing Key Laboratory for HIV/AIDS Research, Capital Medical University, Beijing, 100069, China
| | - Miaotian Cai
- Department of Respiratory and Critical Care Medicine, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China
| | - Yulin Zhang
- Department of Respiratory and Critical Care Medicine, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China.
- Beijing Research Center for Respiratory Infectious Diseases, Beijing, 100069, China.
| | - Tong Zhang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Beijing Key Laboratory for HIV/AIDS Research, Capital Medical University, Beijing, 100069, China.
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Saal CL, Springer P, Seddon JA, van Toorn R, Esterhuizen TM, Solomons RS. Risk factors of poor developmental outcome in children with tuberculous meningitis. Childs Nerv Syst 2022; 39:1029-1039. [PMID: 36525135 PMCID: PMC9756925 DOI: 10.1007/s00381-022-05791-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Neurodevelopmental delay is a significant long-term complication of childhood tuberculous meningitis (TBM). The objective of this study was to assess risk factors for neurodevelopmental delay in children with TBM. METHODS We conducted a retrospective cohort study of children diagnosed with TBM at Tygerberg Hospital, Cape Town, South Africa, over a 30-year period between 1985 and 2015. We assessed the relationship between demographic, clinical, laboratory and neuro-imaging characteristics, and cognitive impairment at the conclusion of anti-tuberculous treatment. Poor outcome was defined as moderate-to severe cognitive impairment. RESULTS A total of 327 TBM patients were included, 71 (21.7%) suffered a poor outcome. Multivariate analysis revealed that decreased level of consciousness (adjusted OR (aOR): 4.68; 95%CI: 2.43-13.88; p = 0.005), brainstem dysfunction (aOR: 3.20; 95%CI: 1.70-6.00; p < 0.001), and radiological infarction (aOR: 3.47; 95%CI: 1.87-6.45; p < 0.001) were associated with a poor developmental outcome. Left hemispherical (single and multiple) stroke and bilateral stroke were associated with poor developmental outcomes. CONCLUSION Certain neurological signs as well as radiological infarct characteristics are important predictors of poor developmental outcome. Anticipation of the likely level of cognitive impairment at diagnosis allows more accurate prognostication and prompt institution of supportive and rehabilitative measures, after the acute illness.
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Affiliation(s)
- Caro-Lee Saal
- Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Priscilla Springer
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 19063, Tygerberg, 7505, South Africa
| | - James A Seddon
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 19063, Tygerberg, 7505, South Africa
- Department of Infectious Disease, Imperial College London, London, UK
| | - Ronald van Toorn
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 19063, Tygerberg, 7505, South Africa
| | - Tonya M Esterhuizen
- Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Regan S Solomons
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 19063, Tygerberg, 7505, South Africa.
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Shridhar A, Garg RK, Rizvi I, Jain M, Ali W, Malhotra HS, Kumar N, Sharma PK, Verma R, Uniyal R, Pandey S. Prevalence of primary immunodeficiency syndromes in tuberculous meningitis: A case-control study. J Infect Public Health 2021; 15:29-35. [PMID: 34883295 DOI: 10.1016/j.jiph.2021.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/18/2021] [Accepted: 11/25/2021] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Only a proportion of patients with tuberculosis develop tuberculous meningitis. We hypothesize that inherent abnormalities in the host's innate or adaptive immune system may affect the outcome in tuberculous meningitis. In this study, we evaluated the proportion of underlying primary immunodeficiency in patients with tuberculous meningitis and its impact on the outcome. METHODS Newly-diagnosed cases with tuberculous meningitis and healthy controls were included. Patients with HIV disease were excluded. Blood specimen were subjected to immunological assessment to detect primary immunodeficiency syndrome/s. We estimated serum levels of IgG, IgA, IgM, IgE and IgD along with complement C3, C4, and C5 assay. Absolute lymphocyte count was obtained from an automated three-part cell counter. Flow cytometry was used to enumerate the following lymphocyte subsets: T Cell (CD3, CD4, CD8), B cell (CD19/CD20), and Natural killer cells (CD16 and CD56). Cases were followed for 6 months. Modified Barthel Index was used as a measure of disability. RESULTS We included 55 cases with tuberculous meningitis and 30 healthy controls. We notedthat among immune parameters, absolute lymphocyte count and CD4 T-cell count in the tuberculous meningitis group was lower; higher serum IgG levels were noted in the poor outcome group. On multivariate regression analysis, none of the immunological, clinical or radiological features were found to predict a poor outcome. CONCLUSION Host's immune factors contribute to the pathogenesis of tuberculous meningitis. Absolute lymphocyte count and CD4+ T-cell count were lower in tuberculous meningitis cases. Higher serum IgG levels may be associated with a poor outcome. A study with a larger sample size is needed to confirm our findings.
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Affiliation(s)
- Abhishek Shridhar
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Ravindra Kumar Garg
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India.
| | - Imran Rizvi
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Mili Jain
- Department of Pathology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Wahid Ali
- Department of Pathology, King George Medical University, Lucknow, Uttar Pradesh, India
| | | | - Neeraj Kumar
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Praveen Kumar Sharma
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Rajesh Verma
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Ravi Uniyal
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Shweta Pandey
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
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Fang MT, Su YF, An HR, Zhang PZ, Deng GF, Liu HM, Mao Z, Zeng JF, Li G, Yang QT, Wang ZY. Decreased mortality seen in rifampicin/multidrug-resistant tuberculous meningitis treated with linezolid in Shenzhen, China. BMC Infect Dis 2021; 21:1015. [PMID: 34583653 PMCID: PMC8480033 DOI: 10.1186/s12879-021-06705-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 09/16/2021] [Indexed: 11/28/2022] Open
Abstract
Background The morbidity of rifampicin/multidrug-resistant tuberculous meningitis (RR/MDR-TBM) has shown an increasing trend globally. Its mortality rate is significantly higher than that of non-rifampicin/multidrug-resistant tuberculous meningitis (NRR/MDR-TBM). This article aimed to explore risk factors related to RR/MDR-TBM, and compare therapeutic effects of linezolid (LZD)- and non-linezolid-containing regimen for RR/MDR-TB patients in Shenzhen city. Furthermore, we aimed to find a better therapy for pathogen-negative TBM with RR/MDR-TBM related risk factors. Methods We conducted a retrospective study enrolling 137 hospitalized cases with confirmed TBM from June 2014 to March 2020. All patients were divided into RR/MDR-TBM group (12 cases) and NRR/MDR-TBM group (125 cases) based on GeneXpert MTB/RIF and (or) phenotypic drug susceptibility test results using cerebral spinal fluid (CSF). The risk factors related to RR/MDR-TBM were investigated through comparing clinical and examination features between the two groups. The mortality rate of RR/MDR-TBM patients treated with different regimens was analyzed to compare their respective therapeutic effects. A difference of P < 0.05 was considered statistically significant. Results Most patients (111/137, 81%) were from southern or southwestern China, and a large proportion (72/137, 52.55%) belonged to migrant workers. 12 cases were RR/MDR-TBM (12/137, 8.8%) while 125 cases were NRR/MDR-TBM (125/137, 91.2%). The proportion of patients having prior TB treatment history in the RR/MDR-TBM group was significantly higher than that of the NRR/MDR-TBM group (6/12 vs. 12/125, 50% vs. 10.5%, P < 0.01). No significant difference was observed on other clinical and examination features between the two groups. Mortality was significantly lower in RR/MDR-TBM patients on linezolid-containing treatment regimen than those who were not (0/7 versus 3/5, 0% versus 60%, P = 0.045). Conclusions The main related risk factor of RR/MDR-TBM is the history of anti-tuberculosis treatment. Linezolid-containing regimen appears to lower mortality rate of RR/MDR-TBM significantly in our study. We think Linezolid should be evaluated prospectively in the treatment of RR/MDR-TBM.
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Affiliation(s)
- Mu-Tong Fang
- National Clinical Research Center for Infectious Disease (Shenzhen), Guangdong Provincial Clinical Research Center for Infectious Diseases (Tuberculosis), Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, 518112, China
| | - You-Feng Su
- National Clinical Research Center for Infectious Disease (Shenzhen), Guangdong Provincial Clinical Research Center for Infectious Diseases (Tuberculosis), Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, 518112, China
| | - Hui-Ru An
- Tuberculosis Sector of 8th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Pei-Ze Zhang
- National Clinical Research Center for Infectious Disease (Shenzhen), Guangdong Provincial Clinical Research Center for Infectious Diseases (Tuberculosis), Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, 518112, China
| | - Guo-Fang Deng
- National Clinical Research Center for Infectious Disease (Shenzhen), Guangdong Provincial Clinical Research Center for Infectious Diseases (Tuberculosis), Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, 518112, China
| | - Hou-Ming Liu
- National Clinical Research Center for Infectious Disease (Shenzhen), Guangdong Provincial Clinical Research Center for Infectious Diseases (Tuberculosis), Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, 518112, China
| | - Zhi Mao
- National Clinical Research Center for Infectious Disease (Shenzhen), Guangdong Provincial Clinical Research Center for Infectious Diseases (Tuberculosis), Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, 518112, China
| | - Jian-Feng Zeng
- National Clinical Research Center for Infectious Disease (Shenzhen), Guangdong Provincial Clinical Research Center for Infectious Diseases (Tuberculosis), Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, 518112, China
| | - Guobao Li
- National Clinical Research Center for Infectious Disease (Shenzhen), Guangdong Provincial Clinical Research Center for Infectious Diseases (Tuberculosis), Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, 518112, China
| | - Qian-Ting Yang
- National Clinical Research Center for Infectious Disease (Shenzhen), Guangdong Provincial Clinical Research Center for Infectious Diseases (Tuberculosis), Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, 518112, China.
| | - Zhong-Yuan Wang
- National Clinical Research Center for Infectious Disease (Shenzhen), Guangdong Provincial Clinical Research Center for Infectious Diseases (Tuberculosis), Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, 518112, China. .,Tuberculosis Sector of 8th Medical Center of Chinese PLA General Hospital, Beijing, China.
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Jadaun P, Patil R, Ramteke S, Goel M. A study to assess the clinico-radiological presentation and outcome predictors in cases of tubercular meningitis. Indian J Tuberc 2020; 68:384-388. [PMID: 34099205 DOI: 10.1016/j.ijtb.2020.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 11/15/2020] [Accepted: 12/28/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Tubercular bacterial meningitis continues to be an important cause of morbidity (especially neurologic handicap) in children from resource-poor countries. The present study was planned to assess the clinical and radiological presentation in cases of tubercular meningitis as well as to study the factors associated with mortality. METHODOLOGY This study was done over a period of 12 months on children between 5 years and 13 years with suspected TBM. Staging of tubercular meningitis was done according to RNTCP Pediatric TB guideline 2019. RESULT The study was conducted on a total of 47 pediatric patients with TBM. Mean age of children in present study was 8.77 ± 2.5 years. Our study documented male preponderance for TBM. Severe thinness was observed in 38.3% patients with TBM. Only 59.6% patients were immunized against tuberculosis and history of contact was documented in 40.5% patients. Maximum children belonged to stage I of TBM (59.6%) followed by stage III and stage II in 34% and 6.4% patients respectively. Montoux test positivity was observed in 14.9% patients only. CSF CBNAAT was positive in 6.4% patients. The most common finding was meningeal enhancement seen in 27.7% of patients followed by tuberculomas in 10.6%.Chest X ray was abnormal in 44.7% patients. In present study mortality was observed in 11 (23.4%) cases. Out of various risk factors, mortality was significantly associated with nutritional status and stage of TBM (p < 0.01). CONCLUSION TBM is associated with high morbidity and mortality in children especially in India where Burden of TB is high. Our study emphasized on the risk factors associated with mortality in children with TBM and need for early diagnosis and appropriate treatment.
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Affiliation(s)
- Priya Jadaun
- Department of Pediatrics, Gandhi Medical College, Bhopal, India
| | - Rajesh Patil
- Department of Pediatrics, Gandhi Medical College, Bhopal, India
| | | | - Manjusha Goel
- Department of Pediatrics, Gandhi Medical College, Bhopal, India.
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Negatu DA, Gengenbacher M, Dartois V, Dick T. Indole Propionic Acid, an Unusual Antibiotic Produced by the Gut Microbiota, With Anti-inflammatory and Antioxidant Properties. Front Microbiol 2020; 11:575586. [PMID: 33193190 PMCID: PMC7652848 DOI: 10.3389/fmicb.2020.575586] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/02/2020] [Indexed: 12/18/2022] Open
Abstract
Most antibiotics are produced by soil microbes and typically interfere with macromolecular synthesis processes as their antibacterial mechanism of action. These natural products are often large and suffer from poor chemical tractability. Here, we discuss discovery, mechanism of action, and the therapeutic potentials of an unusual antibiotic, indole propionic acid (IPA). IPA is produced by the human gut microbiota. The molecule is small, chemically tractable, and targets amino acid biosynthesis. IPA is active against a broad spectrum of mycobacteria, including drug resistant Mycobacterium tuberculosis and non-tuberculous mycobacteria (NTM). Interestingly, the microbiota-produced metabolite is detectable in the serum of healthy individuals, tuberculosis (TB) patients, and several animal models. Thus, the microbiota in our gut may influence susceptibility to mycobacterial diseases. If a gut-lung microbiome axis can be demonstrated, IPA may have potential as a biomarker of disease progression, and development of microbiota-based therapies could be explored. In addition to its antimycobacterial activity, the molecule displays anti-inflammatory and antioxidant properties. This raises the possibility that IPA has therapeutic potential as both antibiotic and add-on host-directed drug for the treatment of TB in patient populations where disease morbidity and mortality is driven by excessive inflammation and tissue damage, such as TB-associated immune reconstitution inflammatory syndrome, TB-meningitis, and TB-diabetes.
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Affiliation(s)
- Dereje Abate Negatu
- Center for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, United States
| | - Martin Gengenbacher
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, United States.,Department of Medical Sciences, Hackensack Meridian School of Medicine, Nutley, NJ, United States
| | - Véronique Dartois
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, United States.,Department of Medical Sciences, Hackensack Meridian School of Medicine, Nutley, NJ, United States
| | - Thomas Dick
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, United States.,Department of Medical Sciences, Hackensack Meridian School of Medicine, Nutley, NJ, United States.,Department of Microbiology and Immunology, Georgetown University, Washington, DC, United States
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García-Caballero A, Navarro-San Francisco C, Martínez-García L, López-Martinez MJ, Corral-Corral I, Gómez-Mampaso E, Cantón R, Tato-Diez M. Forty years of Tuberculous meningitis: The new face of an old enemy. Int J Infect Dis 2020; 99:62-68. [PMID: 32730828 DOI: 10.1016/j.ijid.2020.07.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/16/2020] [Accepted: 07/23/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Tuberculous meningitis (TBM) occurs in 1-5% of cases of tuberculosis. Without early treatment, mortality and permanent disability rates are high. METHODS A retrospective study performed at a tertiary hospital in Madrid (Spain) to describe clinical, diagnostic, and therapeutic aspects of TBM and analyze epidemiological trends over forty years, divided into two intervals (1979-1998 and 1999-2018). RESULTS Overall, TBM was diagnosed in 65 patients (1.8% of new tuberculosis diagnoses), 48 in the first period and 17 in the second one. Median age at diagnosis increased from 38.5 to 77 years (p = 0.003). The proportion of non-HIV immunosuppressed patients increased (from 2.1% to 29.4%, p < 0.001), while the percentage of patients with a history of drug-abuse decreased (from 33.3% to 5.9%, p = 0.027). The median time between the onset of neurological symptoms and lumbar puncture increased from seven to 15 days (p = 0.040). The time between the onset of symptoms and the initiation of tuberculostatic treatment also increased from eleven to 18 days (p = 0.555). Results from image, biochemical, and microbiological tests showed no differences between both periods. A decreasing trend was observed in survival rates at 1-week (from 97.9% to 64.7%, p < 0.001), 1-month (from 91.7% to 58.8%, p = 0.002) and 1-year (from 85.4% to 47.1%, p = 0.002) after TBM diagnosis. CONCLUSIONS The profile of patients diagnosed with TBM has changed from a young HIV-infected patient with a history of drug addiction to an elderly patient with non-HIV immunosuppression. Diagnosis and start of treatment both experienced a noticeable delay in the second period, which could help explain the increase in mortality observed across the two periods.
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Affiliation(s)
- A García-Caballero
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain
| | - C Navarro-San Francisco
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain.
| | - L Martínez-García
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - M J López-Martinez
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - I Corral-Corral
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - E Gómez-Mampaso
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - R Cantón
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain
| | - M Tato-Diez
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain
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8
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Kasinathan A, Serane VK, Palanisamy S. Tuberculous meningitis manifesting with neuroregression in a eleven month child. Indian J Tuberc 2020; 67:136-138. [PMID: 32192608 DOI: 10.1016/j.ijtb.2020.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 01/01/2020] [Indexed: 10/25/2022]
Abstract
Tuberculosis (TB) is a disease of diverse manifestations. In children, neurotuberculosis is the severest form, which when left untreated can have deleterious consequences. There has been reports on pediatric TB meningitis manifesting with fever and seizures, altered sensorium or focal deficits. There are reports on TB meningitis presenting with cognitive decline in adults. We are reporting a eleven month old girl child who presented with acute regression of attained developmental milestones of one month duration as the only presenting complaint and MRI brain revealed basal exudates with hydrocephalus which nailed the diagnosis of tuberculous meningitis. CSF (Cerebro Spinal Fluid) tested by CBNAAT (Cartridge Based Nucleic Acid Amplification Testing) for TB was negative, but gastric aspirate tested for the same, came positive. Tuberculin skin testing was also positive. Chest X-ray was normal. The child had not received BCG (Bacillus Calmette Guerin)vaccine, thereby increasing her risk of complicated TB. The contact couldn't be traced. The child was started on ATT (Anti Tubercular Treatment) as soon as the diagnosis was made and she improved, thus signifying the better outcome with early initiation of ATT. This case reporting is intended to highlight the unusual presentation of TB meningitis in children, which when clinicians are aware of will lead to early treatment and better prognosis.
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Affiliation(s)
- Ananthanarayanan Kasinathan
- Department of Pediatrics, Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidyapeeth University, Pillayarkuppam, Puducherry, 607402, India
| | - Vikneswari Karthiga Serane
- Department of Pediatrics, Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidyapeeth University, Pillayarkuppam, Puducherry, 607402, India.
| | - Soundararajan Palanisamy
- Department of Pediatrics, Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidyapeeth University, Pillayarkuppam, Puducherry, 607402, India
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Jaipuriar RS, Garg RK, Rizvi I, Malhotra HS, Kumar N, Jain A, Verma R, Sharma PK, Pandey S, Uniyal R. Early Mortality among Immunocompetent Patients of Tuberculous Meningitis: A Prospective Study. Am J Trop Med Hyg 2020; 101:357-361. [PMID: 31237232 DOI: 10.4269/ajtmh.19-0098] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Most deaths in tuberculous meningitis occur in the early part of the illness. We assessed the determinants of early deaths, occurring within 2 months of intensive therapy. We prospectively included consecutive newly diagnosed adults with HIV-negative tuberculous meningitis. Patients were given WHO-recommended antituberculosis treatment and were followed up for 9 months. We enrolled 152 patients. A total of 26 deaths were recorded during 2 months. The logistic regression analysis revealed that papilledema (P = 0.029, odds ratio (OR) = 4.8 [1.2-19.8]), increasing age (P = 0.001, OR = 1.07 [1.03-1.1]), stage-III disease (Glasgow coma scale score ≤ 10; P = 0.01, OR = 4.2 [1.4-12.3]), and hydrocephalus (P = 0.003, OR = 8.4 [2.1-33.6]) were independently associated with death. In addition, cerebral infarcts (P = 0.012, OR = 5.6 [1.5-21.3]), paraparesis (P = 0.004, OR = 8.8 [2.02-38.1]), and age (P = 0.005, OR = 1.05 [1.02-1.09]) were associated with poor functional outcome. In conclusion, disease severity predicts early deaths in tuberculous meningitis.
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Affiliation(s)
| | | | - Imran Rizvi
- Department of Neurology, King George Medical University, Lucknow, India
| | | | - Neeraj Kumar
- Department of Neurology, King George Medical University, Lucknow, India
| | - Amita Jain
- Department of Microbiology, King George Medical University, Lucknow, India
| | - Rajesh Verma
- Department of Neurology, King George Medical University, Lucknow, India
| | | | - Shweta Pandey
- Department of Neurology, King George Medical University, Lucknow, India
| | - Ravi Uniyal
- Department of Neurology, King George Medical University, Lucknow, India
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Garg RK. Microbiological diagnosis of tuberculous meningitis: Phenotype to genotype. Indian J Med Res 2019; 150:448-457. [PMID: 31939388 PMCID: PMC6977359 DOI: 10.4103/ijmr.ijmr_1145_19] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Indexed: 11/22/2022] Open
Abstract
Tuberculous meningitis (TBM) is a commonly encountered central nervous system infection. Characteristic clinical, imaging and cerebrospinal fluid parameters help clinicians to make a prompt presumptive diagnosis that enables them to start empirical anti-tuberculosis treatment. There are several close mimic to TBM, such as partially treated pyogenic meningitis, fungal meningitis, sarcoidosis, meningeal metastases and meningeal lymphomatosis. Microbiological confirmation instils a sense of confidence amongst treating physicians. With conventional phenotypic methods (cerebrospinal fluid microscopy and culture), in more than 50 per cent patients, microbiological confirmation is not achieved. Moreover, these methods take a long time before providing conclusive results. Negative result does not rule out Mycobacterium tuberculosis infection of the brain. Genotypic methods, such as IS 6110 polymerase chain reaction and automated Xpert M. tuberculosis/rifampicin (MTB/RIF) assay system improved the TBM diagnostics, as results are rapidly available. Xpert MTB/RIF assay, in addition, detects rifampicin resistance. Xpert MTB/RIF Ultra is advanced technology which has higher (60-70%) sensitivity and is being considered a game-changer in the diagnostics of TBM. A large number of TBM cases remain unconfirmed. The situation of TBM diagnostics will remain grim, if low-cost technologies are not widely available. Till then, physicians continue to rely on their clinical acumen to start empirical anti-tuberculosis treatment.
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Affiliation(s)
- Ravindra Kumar Garg
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
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11
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Computed tomography thorax abnormalities in immunocompetent patients with tuberculous meningitis: An observational study. J Neurol Sci 2019; 397:11-15. [DOI: 10.1016/j.jns.2018.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 11/19/2018] [Accepted: 12/05/2018] [Indexed: 11/21/2022]
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12
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1H nuclear magnetic resonance-based metabolic profiling of cerebrospinal fluid to identify metabolic features and markers for tuberculosis meningitis. INFECTION GENETICS AND EVOLUTION 2019; 68:253-264. [PMID: 30615950 DOI: 10.1016/j.meegid.2019.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/18/2018] [Accepted: 01/03/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Tuberculosis meningitis (TBM) is the most severe form of tuberculosis, and currently lacks efficient diagnostic approaches. Metabolomics has the potential to differentiate patients with TBM from those with other forms of meningitis and meningitis-negative individuals. However, no systemic metabolomics research has compared the cerebrospinal fluid (CSF) of these patients. METHODS 1H nuclear magnetic resonance (NMR) was used for CSF metabolic profiling. Principal component analysis and orthogonal signal correction-partial least squares-discriminant analysis (OPLS-DA) were used to screen for important variables. The Human Metabolome Database was used to identify metabolites, and MetaboAnalyst 4.0 was used for pathway analysis and over-representation analysis. RESULTS OPLS-DA modeling could distinguish TBM from other forms of meningitis, and several significantly changed metabolites were identified. Additionally, 23, 6, and 21 metabolites were able to differentiate TBM from viral meningitis, bacterial meningitis, and meningitis-negative groups, respectively. Pathway analysis indicated that these metabolites were mainly involved in carbohydrate and amino acid metabolism, and over-representation analysis indicated that some of these pathways were over-represented. CONCLUSIONS The metabolites identified have the potential to serve as biomarkers for TBM diagnosis, and carbohydrate and amino acid metabolism are perturbed in the CSF of patents with TBM. Metabolomics is a valuable approach for screening TBM biomarkers. With further investigation, the metabolites identified in this study could aid in TBM diagnosis.
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13
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Wasay M, Khan M, Farooq S, Khowaja ZA, Bawa ZA, Mansoor Ali S, Awan S, Beg MA. Frequency and Impact of Cerebral Infarctions in Patients With Tuberculous Meningitis. Stroke 2018; 49:2288-2293. [DOI: 10.1161/strokeaha.118.021301] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Cerebral infarctions complicate a variable proportion of tuberculous meningitis (TBM) cases and adversely affect outcomes. The objective of this study was to evaluate the predictors of cerebral infarcts in patients with TBM and to assess their impact on mortality.
Methods—
The study was based on a retrospective chart review of all patients with TBM admitted to a tertiary care hospital between 2002 and 2013. Data were collected on basic demographics, conventional vascular risk factors, radiological findings, severity of TBM, and neurological outcomes. Data were analyzed using SPSS version 19.0. Binary logistic regression was done to determine the factors predictive of cerebral infarcts and of mortality in patients with TBM.
Results—
A total of 559 patients were admitted with TBM during the study period. Mean age was 41.9 years (SD, 17.7 years), and 47% were women. A quarter of the patients had stage III disease. One hundred forty-four (25.8%) patients had cerebral infarcts on brain imaging of which 3 quarters were acute or subacute. Those with cerebral infarcts were more likely to be >40 years of age (adjusted odds ratio [AOR], 1.7; 95% CI, 1.1–2.7) and to have hypertension (AOR, 1.8; 95% CI, 1.1–2.8), dyslipidemia (AOR, 9.7; 95% CI, 3.8–24.8), and diabetes mellitus (AOR, 2.2; 95% CI, 1.3–3.6). Presence of cerebral infarction was an independent predictor of mortality among patients with TBM (AOR, 2.1; 95% CI, 1.22–3.5).
Conclusions—
Cerebral infarcts complicate a substantial proportion of TBM cases. Conventional vascular risk factors are the most important predictors of infarction, and future efforts need to focus on these high-risk patients with TBM to reduce morbidity and mortality.
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Affiliation(s)
- Mohammad Wasay
- From the Departments of Neurology (M.W., S.F.), Aga Khan University, Karachi, Pakistan
| | - Maria Khan
- Department of Neurology, Rashid Hospital, Dubai, United Arab Emirates (M.K.)
| | - Salman Farooq
- From the Departments of Neurology (M.W., S.F.), Aga Khan University, Karachi, Pakistan
| | - Zubair Ali Khowaja
- Department of Physical Medicine and Rehabilitation, Institute of Physical Medicine and Rehabilitation, Dow University of Health Sciences, Karachi, Pakistan (Z.A.K.)
| | - Zeeshan Ali Bawa
- Department of Medicine, Ankleseria Hospital, Karachi, Pakistan (Z.A.B.)
| | - Shehzad Mansoor Ali
- Department of Public Health, University of Texas Health Science, Houston (S.M.A.)
| | - Safia Awan
- Medicine (S.A.), Aga Khan University, Karachi, Pakistan
| | - M. Asim Beg
- Pathology and Microbiology (M.A.B.), Aga Khan University, Karachi, Pakistan
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14
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Cantier M, Morisot A, Guérot E, Megarbane B, Razazi K, Contou D, Mariotte E, Canet E, De Montmollin E, Dubée V, Boulet E, Gaudry S, Voiriot G, Mayaux J, Pène F, Neuville M, Mourvillier B, Ruckly S, Bouadma L, Wolff M, Timsit JF, Sonneville R. Functional outcomes in adults with tuberculous meningitis admitted to the ICU: a multicenter cohort study. Crit Care 2018; 22:210. [PMID: 30119686 PMCID: PMC6098613 DOI: 10.1186/s13054-018-2140-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 07/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tuberculous meningitis (TBM) is a devastating infection in tuberculosis endemic areas with limited access to intensive care. Functional outcomes of severe adult TBM patients admitted to the ICU in nonendemic areas are not known. METHODS We conducted a retrospective multicenter cohort study (2004-2016) of consecutive TBM patients admitted to 12 ICUs in the Paris area, France. Clinical, biological, and brain magnetic resonance imaging (MRI) findings at admission associated with a poor functional outcome (i.e., a score of 3-6 on the modified Rankin scale (mRS) at 90 days) were identified by logistic regression. Factors associated with 1-year mortality were investigated by Cox proportional hazards modeling. RESULTS We studied 90 patients, of whom 61 (68%) had a score on the Glasgow Coma Scale ≤ 10 at presentation and 63 (70%) required invasive mechanical ventilation. Brain MRI revealed infarction and hydrocephalus in 38/75 (51%) and 25/75 (33%) cases, respectively. A poor functional outcome was observed in 55 (61%) patients and was independently associated with older age (adjusted odds ratio (aOR) 1.03, 95% CI 1.0-1.07), cerebrospinal fluid protein level ≥ 2 g/L (aOR 5.31, 95% CI 1.67-16.85), and hydrocephalus on brain MRI (aOR 17.2, 95% CI 2.57-115.14). By contrast, adjunctive steroids were protective (aOR 0.13, 95% CI 0.03-0.56). The multivariable adjusted hazard ratio of adjunctive steroids for 1-year mortality (47%, 95% CI 37%-59%) was 0.23 (95% CI 0.11-0.44). Among survivors at 1 year, functional independence (mRS of 0-2) was observed in 27/37 (73%, 95% CI 59%-87%) cases. CONCLUSIONS A poor functional outcome in adult TBM patients admitted to the ICU in a nonendemic area is observed in 60% of cases and is independently associated with elevated cerebrospinal fluid protein level and hydrocephalus. Our data also suggest a protective effect of adjunctive steroids, with reduced disability and mortality, irrespective of immune status and severity of disease at presentation. One-year follow-up revealed functional independence in most survivors.
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Affiliation(s)
- Marie Cantier
- Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, Assistance Publique—Hôpitaux de Paris, 46 rue Henri Huchard, 75018 Paris, France
- Department of Neurology, Saint Antoine University Hospital, Assistance Publique—Hôpitaux de Paris, 184 rue du Faubourg Saint Antoine, 75011 Paris, France
| | - Adeline Morisot
- Department of Public Health, L’Archet Hospital, Nice University Hospital, Nice, France
| | - Emmanuel Guérot
- Department of Intensive Care Medicine, Georges Pompidou European Hospital, Assistance Publique—Hôpitaux de Paris, Paris, France
| | - Bruno Megarbane
- Department of Intensive Care Medicine and Toxicology, Lariboisière University Hospital, Assistance Publique—Hôpitaux de Paris, Paris, France
| | - Keyvan Razazi
- Department of Intensive Care Medicine, Henri Mondor University Hospital, Assistance Publique—Hôpitaux de Paris, Paris, France
| | - Damien Contou
- Department of Intensive Care Medicine, Henri Mondor University Hospital, Assistance Publique—Hôpitaux de Paris, Paris, France
| | - Eric Mariotte
- Department of Intensive Care Medicine, Saint-Louis University Hospital, Assistance Publique—Hôpitaux de Paris, Paris, France
| | - Emmanuel Canet
- Department of Intensive Care Medicine, Saint-Louis University Hospital, Assistance Publique—Hôpitaux de Paris, Paris, France
| | - Etienne De Montmollin
- Department of Intensive Care Medicine, Saint-Denis Delafontaine Hospital, Saint-Denis, France
| | - Vincent Dubée
- Department of Intensive Care Medicine, Saint-Antoine University Hospital, Assistance Publique—Hôpitaux de Paris, Paris, France
| | - Eric Boulet
- Department of Intensive Care Medicine, René Dubos Hospital, Pontoise, France
| | - Stéphane Gaudry
- Medical-Surgical Intensive Care Unit, Louis Mourier University Hospital, Assistance Publique—Hôpitaux de Paris, Colombes, France
| | - Guillaume Voiriot
- Department of Intensive Care Medicine, Tenon University Hospital, Assistance Publique—Hôpitaux de Paris, Paris, France
| | - Julien Mayaux
- Department of Pneumology and Intensive Care Medicine, La Pitié-Salpêtrière University Hospital, Assistance Publique—Hôpitaux de Paris, Paris, France
| | - Frédéric Pène
- Department of Intensive Care Medicine, Cochin University Hospital, Assistance Publique—Hôpitaux de Paris, Paris, France
| | - Mathilde Neuville
- Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, Assistance Publique—Hôpitaux de Paris, 46 rue Henri Huchard, 75018 Paris, France
| | - Bruno Mourvillier
- Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, Assistance Publique—Hôpitaux de Paris, 46 rue Henri Huchard, 75018 Paris, France
- UMR 1137, IAME Team 5, DeSCID: Decision SCiences in Infectious Diseases, control and care, INSERM/Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Stéphane Ruckly
- UMR 1137, IAME Team 5, DeSCID: Decision SCiences in Infectious Diseases, control and care, INSERM/Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Lila Bouadma
- Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, Assistance Publique—Hôpitaux de Paris, 46 rue Henri Huchard, 75018 Paris, France
- UMR 1137, IAME Team 5, DeSCID: Decision SCiences in Infectious Diseases, control and care, INSERM/Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Michel Wolff
- Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, Assistance Publique—Hôpitaux de Paris, 46 rue Henri Huchard, 75018 Paris, France
| | - Jean-François Timsit
- Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, Assistance Publique—Hôpitaux de Paris, 46 rue Henri Huchard, 75018 Paris, France
- UMR 1137, IAME Team 5, DeSCID: Decision SCiences in Infectious Diseases, control and care, INSERM/Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Romain Sonneville
- Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, Assistance Publique—Hôpitaux de Paris, 46 rue Henri Huchard, 75018 Paris, France
- UMR 1148, Laboratory for Vascular and Translational Science, INSERM/Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - ENCEPHALITICA study group
- Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, Assistance Publique—Hôpitaux de Paris, 46 rue Henri Huchard, 75018 Paris, France
- Department of Public Health, L’Archet Hospital, Nice University Hospital, Nice, France
- Department of Intensive Care Medicine, Georges Pompidou European Hospital, Assistance Publique—Hôpitaux de Paris, Paris, France
- Department of Intensive Care Medicine and Toxicology, Lariboisière University Hospital, Assistance Publique—Hôpitaux de Paris, Paris, France
- Department of Intensive Care Medicine, Henri Mondor University Hospital, Assistance Publique—Hôpitaux de Paris, Paris, France
- Department of Intensive Care Medicine, Saint-Louis University Hospital, Assistance Publique—Hôpitaux de Paris, Paris, France
- Department of Intensive Care Medicine, Saint-Denis Delafontaine Hospital, Saint-Denis, France
- Department of Intensive Care Medicine, Saint-Antoine University Hospital, Assistance Publique—Hôpitaux de Paris, Paris, France
- Department of Intensive Care Medicine, René Dubos Hospital, Pontoise, France
- Medical-Surgical Intensive Care Unit, Louis Mourier University Hospital, Assistance Publique—Hôpitaux de Paris, Colombes, France
- Department of Intensive Care Medicine, Tenon University Hospital, Assistance Publique—Hôpitaux de Paris, Paris, France
- Department of Pneumology and Intensive Care Medicine, La Pitié-Salpêtrière University Hospital, Assistance Publique—Hôpitaux de Paris, Paris, France
- Department of Intensive Care Medicine, Cochin University Hospital, Assistance Publique—Hôpitaux de Paris, Paris, France
- UMR 1137, IAME Team 5, DeSCID: Decision SCiences in Infectious Diseases, control and care, INSERM/Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- UMR 1148, Laboratory for Vascular and Translational Science, INSERM/Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- Department of Neurology, Saint Antoine University Hospital, Assistance Publique—Hôpitaux de Paris, 184 rue du Faubourg Saint Antoine, 75011 Paris, France
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15
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Zhang P, Zhang W, Lang Y, Qu Y, Chu F, Chen J, Cui L. Mass spectrometry-based metabolomics for tuberculosis meningitis. Clin Chim Acta 2018; 483:57-63. [PMID: 29678632 DOI: 10.1016/j.cca.2018.04.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 04/14/2018] [Accepted: 04/16/2018] [Indexed: 02/07/2023]
Abstract
Tuberculosis meningitis (TBM) is a prevalent form of extra-pulmonary tuberculosis that causes substantial morbidity and mortality. Diagnosis of TBM is difficult because of the limited sensitivity of existing laboratory techniques. A metabolomics approach can be used to investigate the sets of metabolites of both bacteria and host, and has been used to clarify the mechanisms underlying disease development, and identify metabolic changes, leadings to improved methods for diagnosis, treatment, and prognostication. Mass spectrometry (MS) is a major analysis platform used in metabolomics, and MS-based metabolomics provides wide metabolite coverage, because of its high sensitivity, and is useful for the investigation of Mycobacterium tuberculosis (Mtb) and related diseases. It has been used to investigate TBM diagnosis; however, the processes involved in the MS-based metabolomics approach are complex and flexible, and often consist of several steps, and small changes in the methods used can have a huge impact on the final results. Here, the process of MS-based metabolomics is summarized and its applications in Mtb and Mtb-related diseases discussed. Moreover, the current status of TBM metabolomics is described.
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Affiliation(s)
- Peixu Zhang
- Department of Neurology, First Hospital, Jilin University, Changchun 130021, PR China
| | - Weiguanliu Zhang
- Department of Neurology, First Hospital, Jilin University, Changchun 130021, PR China
| | - Yue Lang
- Department of Neurology, First Hospital, Jilin University, Changchun 130021, PR China
| | - Yan Qu
- Blood Bank, Jilin Women and Children Health Hospital, Changchun 130021, PR China
| | - Fengna Chu
- Department of Neurology, First Hospital, Jilin University, Changchun 130021, PR China
| | - Jiafeng Chen
- Department of Neurology, First Hospital, Jilin University, Changchun 130021, PR China
| | - Li Cui
- Department of Neurology, First Hospital, Jilin University, Changchun 130021, PR China.
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16
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Li Z, Du B, Li J, Zhang J, Zheng X, Jia H, Xing A, Sun Q, Liu F, Zhang Z. Cerebrospinal fluid metabolomic profiling in tuberculous and viral meningitis: Screening potential markers for differential diagnosis. Clin Chim Acta 2017; 466:38-45. [PMID: 28063937 DOI: 10.1016/j.cca.2017.01.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 01/01/2017] [Accepted: 01/03/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Tuberculous meningitis (TBM) is the most severe and frequent form of central nervous system tuberculosis. The current lack of efficient diagnostic tests makes it difficult to differentiate TBM from other common types of meningitis, especially viral meningitis (VM). Metabolomics is an important tool to identify disease-specific biomarkers. However, little metabolomic information is available on adult TBM. METHODS We used 1H nuclear magnetic resonance-based metabolomics to investigate the metabolic features of the CSF from 18 TBM and 20 VM patients. Principal component analysis and orthogonal signal correction-partial least squares-discriminant analysis (OSC-PLS-DA) were applied to analyze profiling data. Metabolites were identified using the Human Metabolome Database and pathway analysis was performed with MetaboAnalyst 3.0. RESULTS The OSC-PLS-DA model could distinguish TBM from VM with high reliability. A total of 25 key metabolites that contributed to their discrimination were identified, including some, such as betaine and cyclohexane, rarely reported before in TBM. Pathway analysis indicated that amino acid and energy metabolism was significantly different in the CSF of TBM compared with VM. CONCLUSIONS Twenty-five key metabolites identified in our study may be potential biomarkers for TBM differential diagnosis and are worthy of further investigation.
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Affiliation(s)
- Zihui Li
- Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing 101149, China
| | - Boping Du
- Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing 101149, China
| | - Jing Li
- People's Liberation Army No. 263 Hospital, Beijing 101149, China
| | - Jinli Zhang
- People's Liberation Army No. 263 Hospital, Beijing 101149, China
| | - Xiaojing Zheng
- Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing 101149, China
| | - Hongyan Jia
- Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing 101149, China
| | - Aiying Xing
- Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing 101149, China
| | - Qi Sun
- Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing 101149, China
| | - Fei Liu
- Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing 101149, China
| | - Zongde Zhang
- Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing 101149, China.
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17
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Abstract
In 2015, the World Health Organization (WHO) declared tuberculosis (TB) to be responsible for more deaths than any other single infectious disease. The burden of TB among children has frequently been dismissed as relatively low with resulting deaths contributing very little to global under-five all-cause mortality, although without rigorous estimates of these statistics, the burden of childhood TB was, in reality, unknown. Recent work in the area has resulted in a WHO estimate of 1 million new cases of childhood TB in 2014 resulting in 136,000 deaths. Around 3% of these cases likely have multidrug-resistant TB and at least 40,000 are in HIV-infected children. TB is now thought to be a major or contributory cause of many deaths in children under five years old, despite not being recorded as such, and is likely in the top ten causes of global mortality in this age group. In particular, recent work has shown that TB is an under-lying cause of a substantial proportion of pneumonia deaths in TB-endemic countries. Childhood TB should be given higher priority: we need to identify children at greatest risk of TB disease and death and make more use of tools such as active case-finding and preventive therapy. TB is a preventable and treatable disease from which no child should die.
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Affiliation(s)
- Helen E. Jenkins
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118 USA
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18
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Israni AV, Dave DA, Mandal A, Singh A, Sahi PK, Das RR, Shah A. Tubercular meningitis in children: Clinical, pathological, and radiological profile and factors associated with mortality. J Neurosci Rural Pract 2016; 7:400-4. [PMID: 27365958 PMCID: PMC4898109 DOI: 10.4103/0976-3147.181475] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT Childhood tuberculosis is a major public health problem in developing countries with tubercular meningitis being a serious complication with high mortality and morbidity. AIM To study the clinicopathological as well as radiological profile of childhood tuberculous meningitis (TBM) cases. SETTINGS AND DESIGN Prospective, observational study including children <14 years of age with TBM admitted in a tertiary care hospital from Western India. SUBJECTS AND METHODS TBM was diagnosed based on predefined criteria. Glassgow coma scale (GCS) and intracranial pressure (ICP) was recorded. Staging was done as per British Medical Council Staging System. Mantoux test, chest X-ray, cerebrospinal fluid (CSF) examination, neuroimaging, and other investigations were done to confirm TB. STATISTICAL ANALYSIS USED STATA software (version 9.0) was used for data analysis. Various risk factors were determined using Chi-square tests, and a P< 0.05 was considered significant. RESULTS Forty-seven children were included, of which 11 (24.3%) died. Fever was the most common presenting symptom, and meningismus was the most common sign. Twenty-nine (62%) children presented with Stage III disease. Stage III disease, low GCS, and raised ICP were predictors of mortality. Findings on neuroimaging or CSF examination did not predict mortality. CONCLUSIONS Childhood TBM presents with nonspecific clinical features. Stage III disease, low GCS, lack of Bacillus Calmette-Guérin vaccination at birth and raised ICP seem to the most important adverse prognostic factors.
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Affiliation(s)
- Anil V Israni
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Divya A Dave
- Department of Pediatrics, Medical College Baroda and SSG Hospital, Vadodara, Gujarat, India
| | - Anirban Mandal
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Amitabh Singh
- Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, New Delhi, India
| | - Puneet K Sahi
- Department of Pediatrics, Kalawati Saran Children Hospital, New Delhi, India
| | - Rashmi Ranjan Das
- Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Arpita Shah
- Department of Pathology, Toprani Advanced Lab Systems, Vadodara, Gujarat, India
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19
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Rizvi I, Garg RK, Jain A, Malhotra HS, Singh AK, Prakash S, Kumar N, Garg R, Verma R, Mahdi AA, Sharma PK. Vitamin D status, vitamin D receptor and toll like receptor-2 polymorphisms in tuberculous meningitis: a case–control study. Infection 2016; 44:633-40. [DOI: 10.1007/s15010-016-0907-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 05/07/2016] [Indexed: 12/19/2022]
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20
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Jha SK, Garg RK, Jain A, Malhotra HS, Verma R, Sharma PK. Definite (microbiologically confirmed) tuberculous meningitis: predictors and prognostic impact. Infection 2015; 43:639-45. [DOI: 10.1007/s15010-015-0756-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 02/20/2015] [Indexed: 11/24/2022]
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