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Maharani K, Dian S, Ganiem AR, Imran D, Estiasari R, Ardiansyah E, Andini PW, Kristina F, Pangeran D, Chaidir L, Alisjahbana B, Rukmana A, Kusumaningrum A, Adawiyah R, Subekti D, Yunihastuti E, Yunus RE, Waslia L, van Ingen J, van Laarhoven A, Hamers RL, van Crevel R. Clinical presentation, management, and outcome of suspected central nervous system infections in Indonesia: a prospective cohort study. Infection 2024; 52:583-595. [PMID: 38315377 PMCID: PMC10954958 DOI: 10.1007/s15010-023-02170-0] [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: 09/08/2023] [Accepted: 12/27/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Little is known about the etiology, clinical presentation, management, and outcome of central nervous system (CNS) infections in Indonesia, a country with a high burden of infectious diseases and a rising prevalence of HIV. METHODS We included adult patients with suspected CNS infections at two referral hospitals in a prospective cohort between April 2019 and December 2021. Clinical, laboratory, and radiological assessments were standardized. We recorded initial and final diagnoses, treatments, and outcomes during 6 months of follow-up. RESULTS Of 1051 patients screened, 793 were diagnosed with a CNS infection. Patients (median age 33 years, 62% male, 38% HIV-infected) presented a median of 14 days (IQR 7-30) after symptom onset, often with altered consciousness (63%), motor deficits (73%), and seizures (21%). Among HIV-uninfected patients, CNS tuberculosis (TB) was most common (60%), while viral (8%) and bacterial (4%) disease were uncommon. Among HIV-infected patients, cerebral toxoplasmosis (41%) was most common, followed by CNS TB (19%), neurosyphilis (15%), and cryptococcal meningitis (10%). A microbiologically confirmed diagnosis was achieved in 25% of cases, and initial diagnoses were revised in 46% of cases. In-hospital mortality was 30%, and at six months, 45% of patients had died, and 12% suffered from severe disability. Six-month mortality was associated with older age, HIV, and severe clinical, radiological and CSF markers at presentation. CONCLUSION CNS infections in Indonesia are characterized by late presentation, severe disease, frequent HIV coinfection, low microbiological confirmation and high mortality. These findings highlight the need for earlier disease recognition, faster and more accurate diagnosis, and optimized treatment, coupled with wider efforts to improve the uptake of HIV services.
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Affiliation(s)
- Kartika Maharani
- Department of Neurology, Faculty of Medicine, Dr. Cipto Mangunkusumo, General Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Sofiati Dian
- Department of Neurology, Faculty of Medicine, Dr. Hasan Sadikin General Hospital, Universitas Padjadjaran, Bandung, Indonesia.
- Research Center for Care and Control of Infectious Disease (RC3ID), Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.
| | - Ahmad Rizal Ganiem
- Department of Neurology, Faculty of Medicine, Dr. Hasan Sadikin General Hospital, Universitas Padjadjaran, Bandung, Indonesia
- Research Center for Care and Control of Infectious Disease (RC3ID), Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Darma Imran
- Department of Neurology, Faculty of Medicine, Dr. Cipto Mangunkusumo, General Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Riwanti Estiasari
- Department of Neurology, Faculty of Medicine, Dr. Cipto Mangunkusumo, General Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Edwin Ardiansyah
- Research Center for Care and Control of Infectious Disease (RC3ID), Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Putri Widya Andini
- Department of Neurology, Faculty of Medicine, Dr. Cipto Mangunkusumo, General Hospital, Universitas Indonesia, Jakarta, Indonesia
- Oxford University Clinical Research Unit Indonesia, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Fransisca Kristina
- Research Center for Care and Control of Infectious Disease (RC3ID), Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - David Pangeran
- Department of Neurology, Faculty of Medicine, Dr. Cipto Mangunkusumo, General Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Lidya Chaidir
- Research Center for Care and Control of Infectious Disease (RC3ID), Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Bachti Alisjahbana
- Research Center for Care and Control of Infectious Disease (RC3ID), Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Andriansjah Rukmana
- Department of Microbiology, Faculty of Medicine, Dr. Cipto Mangunkusumo General Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Ardiana Kusumaningrum
- Department of Microbiology, Faculty of Medicine, Dr. Cipto Mangunkusumo General Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Robiatul Adawiyah
- Department of Parasitology, Faculty of Medicine, Dr. Cipto Mangunkusumo General Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Decy Subekti
- Oxford University Clinical Research Unit Indonesia, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Evy Yunihastuti
- Department of Internal Medicine, Faculty of Medicine, Dr. Cipto Mangunkusumo General Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Reyhan Eddy Yunus
- Department of Radiology, Faculty of Medicine, Dr. Cipto Mangunkusumo General Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Lia Waslia
- Oxford University Clinical Research Unit Indonesia, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Jakko van Ingen
- Department of Microbiology, Radboud Centre for Infectious Diseases (RCI), Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Arjan van Laarhoven
- Department of Internal Medicine, Radboud Centre for Infectious Diseases (RCI), Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Raph L Hamers
- Oxford University Clinical Research Unit Indonesia, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Center for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Reinout van Crevel
- Department of Internal Medicine, Radboud Centre for Infectious Diseases (RCI), Radboud University Medical Centre, Nijmegen, The Netherlands
- Center for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Lubis IND, Farah S, Pasaribu AP, Evalina R, Daulay RS, Wijaya H. A pediatric case and literature review of mucormycosis: Diagnostic and treatment challenges in a resource poor setting. NARRA J 2023; 3:e426. [PMID: 38450345 PMCID: PMC10914060 DOI: 10.52225/narra.v3i3.426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 12/15/2023] [Indexed: 03/08/2024]
Abstract
Mucormycosis is an emerging disease that primarily affects immunocompromised patients; however, it has also been reported in immunocompetent individuals. Studies in the pediatric population are limited and reported mostly in case studies or series. The aim of this case report is to present a pediatric mucormycosis originated from Sumatra Island, Indonesia. A 13-year-old boy was referred to a tertiary hospital with facial necrosis involving the nasal, oral, and left maxillary areas, as well as left periorbital edema. No known underlying conditions were documented. The diagnosis was confirmed by histopathological findings of broad, pauci-septate, ribbon-like hyphae branching at 90°. The patient was managed by a multidisciplinary team consisting of the ear, nose, and throat, infectious diseases, dermatology, surgery, microbiology, and pathology departments. Management of the patient included debridement of the necrotic lesion and antibiotics and anti-fungal (fluconazole). Due to unavailability, the patient was not treated with amphotericin B. The patient died after 30 days of admission. This case highlights the importance of maintaining a high suspicion of invasive mucormycosis, even in immunocompetent children, when symptoms and signs are present, especially in resource-limited settings.
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Affiliation(s)
- Inke ND. Lubis
- Department of Pediatrics, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
- University of Oxford, Oxford, United Kingdom
- Menzies School of Health Research, Darwin, Australia
| | - Sara Farah
- University of Oxford, Oxford, United Kingdom
| | - Ayodhia P. Pasaribu
- Department of Pediatrics, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Rita Evalina
- Department of Pediatrics, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Rini S. Daulay
- Department of Pediatrics, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Hendri Wijaya
- Department of Pediatrics, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
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Kozioł A, Pupek M, Lewandowski Ł. Application of metabolomics in diagnostics and differentiation of meningitis: A narrative review with a critical approach to the literature. Biomed Pharmacother 2023; 168:115685. [PMID: 37837878 DOI: 10.1016/j.biopha.2023.115685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/28/2023] [Accepted: 10/08/2023] [Indexed: 10/16/2023] Open
Abstract
Due to its high mortality rate associated with various life-threatening sequelae, meningitis poses a vital problem in contemporary medicine. Numerous algorithms, many of which were derived with the aid of artificial intelligence, were brought up in a strive for perfection in predicting the status of sepsis-related survival or exacerbation. This review aims to provide key insights on the contextual utilization of metabolomics. The aim of this the metabolomic approach set of methods can be used to investigate both bacterial and host metabolite sets from both the host and its microbes in several types of specimens - even in one's breath, mainly with use of two methods - Mass Spectrometry (MS) and Nuclear Magnetic Resonance (NMR). Metabolomics, and has been used to elucidate the mechanisms underlying disease development and metabolic identification changes in a wide range of metabolite contents, leading to improved methods of diagnosis, treatment, and prognosis of meningitis. Mass spectrometry (MS) and Nuclear Magnetic Resonance (NMR) are the main analytical platforms used in metabolomics. Its high sensitivity accounts for the usefulness of metabolomics in studies into meningitis, its sequelae, and concomitant comorbidities. Metabolomics approaches are a double-edged sword, due to not only their flexibility, but also - high complexity, as even minor changes in the multi-step methods can have a massive impact on the results. Information on the differential diagnosis of meningitis act as a background in presenting the merits and drawbacks of the use of metabolomics in context of meningeal infections.
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Affiliation(s)
- Agata Kozioł
- Department of Immunochemistry and Chemistry, Wrocław Medical University, M. Skłodowskiej-Curie Street 48/50, 50-369 Wrocław, Poland
| | - Małgorzata Pupek
- Department of Immunochemistry and Chemistry, Wrocław Medical University, M. Skłodowskiej-Curie Street 48/50, 50-369 Wrocław, Poland.
| | - Łukasz Lewandowski
- Department of Medical Biochemistry, Wrocław Medical University, T. Chałubińskiego Street 10, 50-368 Wrocław, Poland
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4
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Alisjahbana DH, Nurmawati S, Milanti M, Djauhari H, Ledermann JP, Antonjaya U, Dewi YP, Johar E, Wiyatno A, Sriyani IY, Alisjahbana B, Safari D, Myint KSA, Powers AM, Hakim DDL. Central nervous system infection in a pediatric population in West Java. PLoS Negl Trop Dis 2023; 17:e0011769. [PMID: 38011279 PMCID: PMC10703213 DOI: 10.1371/journal.pntd.0011769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 12/07/2023] [Accepted: 11/03/2023] [Indexed: 11/29/2023] Open
Abstract
Central nervous system (CNS) viral infections are critical causes of morbidity and mortality in children; however, comprehensive data on etiology is lacking in developing countries such as Indonesia. To study the etiology of CNS infections in a pediatric population, 50 children admitted to two hospitals in Bandung, West Java, during 2017-2018 were enrolled in a CNS infection study. Cerebrospinal fluid and serum specimens were tested using molecular, serological, and virus isolation platforms for a number of viral and bacteriological agents. Causal pathogens were identified in 10 out of 50 (20%) and included cytomegalovirus (n = 4), Streptococcus pneumoniae (n = 2), tuberculosis (n = 2), Salmonella serotype Typhi (n = 1) and dengue virus (n = 1). Our study highlights the importance of using a wide range of molecular and serological detection methods to identify CNS pathogens, as well as the challenges of establishing the etiology of CNS infections in pediatric populations of countries with limited laboratory capacity.
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Affiliation(s)
- Dewi H. Alisjahbana
- Department of Child Health, Hasan Sadikin Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Syndi Nurmawati
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia
| | - Mia Milanti
- Department of Child Health, Hasan Sadikin Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Hofiya Djauhari
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia
| | - Jeremy P. Ledermann
- Centers for Disease Control and Prevention, Fort Collins, Colorado, United States of America
| | - Ungke Antonjaya
- Oxford University Clinical Research Unit Indonesia, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Emerging Virus Research Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Yora Permata Dewi
- Emerging Virus Research Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Edison Johar
- Emerging Virus Research Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Ageng Wiyatno
- Emerging Virus Research Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Ida Yus Sriyani
- Emerging Virus Research Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Bachti Alisjahbana
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia
- Department of Internal Medicine, Hasan Sadikin Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Dodi Safari
- Eijkman Research Center for Molecular Biology, National Research and Innovation Agency, Jakarta, Indonesia
| | - Khin Saw Aye Myint
- Emerging Virus Research Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Ann M. Powers
- Centers for Disease Control and Prevention, Fort Collins, Colorado, United States of America
| | - Dzulfikar DL Hakim
- Department of Child Health, Hasan Sadikin Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
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Abstract
Toxoplasma gondii infection in the central nervous system commonly occurs among immunodeficient patients. Its prevalence is high in countries with a high burden of HIV and low coverage of antiretroviral drugs. The brain is one of the predilections for T. gondii infection due to its low inflammatory reaction, and cerebral toxoplasmosis occurs solely due to the reactivation of a latent infection rather than a new infection. Several immune elements have recently been recognized to have an essential role in the immunopathogenesis of cerebral toxoplasmosis. Although real-time isothermal amplification, next-generation sequencing, and enzyme-linked aptamer assays from blood samples have been the recommended diagnostic tools in some in-vivo studies, a combination of clinical symptoms, serology examination, and neuroimaging are still the daily standard for the presumptive diagnosis of cerebral toxoplasmosis and early anti-toxoplasma administration. Clinical trials are needed to find a new therapy that is less likely to affect folate synthesis, have neuroprotective properties, or cure the latent phase of infection. The development of a vaccine is being extensively tested in animals, but its efficacy and safety for humans are still not proven.
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Affiliation(s)
- Sofiati Dian
- Department of Neurology, Faculty of Medicine, Universitas Padjdjaran/Hasan Sadikin Hospital, Bandung, Indonesia
- Health Research Unit, Faculty of Medicine, Padjadjaran University/Hasan Sadikin Hospital, Bandung, Indonesia
| | - Ahmad Rizal Ganiem
- Department of Neurology, Faculty of Medicine, Universitas Padjdjaran/Hasan Sadikin Hospital, Bandung, Indonesia
- Health Research Unit, Faculty of Medicine, Padjadjaran University/Hasan Sadikin Hospital, Bandung, Indonesia
| | - Savira Ekawardhani
- Parasitology Division, Department of Biomedical Sciences, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
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6
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Telles JPM, Vidal JE. Cerebral toxoplasmosis with neurological co-infection in people living with AIDS/HIV: results of a prospective cohort in São Paulo, Brazil. ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:33-39. [PMID: 36918005 PMCID: PMC10014194 DOI: 10.1055/s-0042-1759758] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND Concomitant neurological diseases in people living with HIV/AIDS (PLWHA) is a challenging subject that has been insufficiently evaluated by prospective clinical studies. The goal of the present study was to identify the clinical characteristics and outcomes of PLWHA with cerebral toxoplasmosis and neurological co-infections. METHODS We conducted a prospective observational cohort study at a tertiary teaching center in São Paulo, Brazil, from January to July 2017. Hospitalized PLWHA aged ≥ 18 years with cerebral toxoplasmosis were consecutively enrolled. A standardized neurological examination was performed at admission and weekly until discharge or death. Diagnosis and treatment followed institutional routines; neuroradiology, molecular diagnosis, neurosurgery, and the intensive care unit (ICU) were available. The main outcomes were neurological coinfections and in-hospital death. RESULTS We included 44 (4.3%) cases among 1,032 hospitalized patients. The median age was 44 (interquartile range [IQR]: 35-50) years, and 50% (n = 22) of the patients were male. The median CD4+ T lymphocyte count was of 50 (IQR: 15-94) cells/mm3. Multiple lesions on computed tomography were present in 59% of the cases. Neurological coinfections were diagnosed in 20% (n = 9) of the cases, and cytomegalovirus was the most common etiology (encephalitis: n = 3; polyradiculopathy: n = 2). Longer hospital stays (30 versus 62 days; p = 0.021) and a higher rate of ICU admissions (14% versus 44%; p = 0.045) were observed among PLWHA with neurological coinfections in comparison to those without them. The rate of in-hospital mortality was of 13.6% (n = 6) (coinfection group: 33%; no coinfection group: 8.6%; p = 0.054). CONCLUSION Neurological c-infections were common among PLWHA with cerebral toxoplasmosis, and cytomegalovirus was the main copathogen. The group of PLWHA with neurological co-infections underwent longer hospital stays and more frequent intensive care unit admissions. Additionally, this group of patients tended to have higher in-hospital mortality rate.
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Affiliation(s)
- João Paulo Marochi Telles
- Instituto de Infectologia Emílio Ribas, São Paulo SP, Brazil.,Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo SP, Brazil
| | - José Ernesto Vidal
- Instituto de Infectologia Emílio Ribas, São Paulo SP, Brazil.,Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo SP, Brazil
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Ma Q, Yi Y, Liu T, Wen X, Shan F, Feng F, Yan Q, Shen J, Yang G, Shi Y. MRI-based radiomics signature for identification of invisible basal cisterns changes in tuberculous meningitis: a preliminary multicenter study. Eur Radiol 2022; 32:8659-8669. [PMID: 35748898 PMCID: PMC9226270 DOI: 10.1007/s00330-022-08911-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 04/27/2022] [Accepted: 05/27/2022] [Indexed: 12/04/2022]
Abstract
Objective To develop and evaluate a radiomics signature based on magnetic resonance imaging (MRI) from multicenter datasets for identification of invisible basal cisterns changes in tuberculous meningitis (TBM) patients. Methods Our retrospective study enrolled 184 TBM patients and 187 non-TBM controls from 3 Chinese hospitals (training dataset, 158 TBM patients and 159 non-TBM controls; testing dataset, 26 TBM patients and 28 non-TBM controls). nnU-Net was used to segment basal cisterns in fluid-attenuated inversion recovery (FLAIR) images. Subsequently, radiomics features were extracted from segmented basal cisterns in FLAIR and T2-weighted (T2W) images. Feature selection was carried out in three steps. Support vector machine (SVM) and logistic regression (LR) classifiers were applied to construct the radiomics signature to directly identify basal cisterns changes in TBM patients. Finally, the diagnostic performance was evaluated by the receiver operating characteristic (ROC) curve analysis, calibration curve, and decision curve analysis (DCA). Results The segmentation model achieved the mean Dice coefficients of 0.920 and 0.727 in the training and testing datasets, respectively. The SVM model with 7 T2WI–based radiomics features achieved best discrimination capability for basal cisterns changes with an AUC of 0.796 (95% CI, 0.744–0.847) in the training dataset, and an AUC of 0.751 (95% CI, 0.617–0.886) with good calibration in the testing dataset. DCA confirmed its clinical usefulness. Conclusion The T2WI–based radiomics signature combined with deep learning segmentation could provide a fully automatic, non-invasive tool to identify invisible changes of basal cisterns, which has the potential to assist in the diagnosis of TBM. Key Points • The T2WI–based radiomics signature was useful for identifying invisible basal cistern changes in TBM. • The nnU-Net model achieved acceptable results for the auto-segmentation of basal cisterns. • Combining radiomics and deep learning segmentation provided an automatic, non-invasive approach to assist in the diagnosis of TBM.
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Affiliation(s)
- Qiong Ma
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.,Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
| | - Yinqiao Yi
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, China
| | - Tiejun Liu
- Department of Radiology, Liuzhou People's Hospital, Liuzhou, Guangxi Zhuang Autonomous Region, China
| | - Xinnian Wen
- Department of Radiology, Guangxi Zhuang Autonomous Region Chest Hospital, Liuzhou, Guangxi Zhuang Autonomous Region, China
| | - Fei Shan
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Feng Feng
- Department of Radiology, Nantong Tumor Hospital, Nantong, Jiangsu, China
| | - Qinqin Yan
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Jie Shen
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Guang Yang
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, China.
| | - Yuxin Shi
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
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Wang Y, Liu Y, Chen R, Qiao L. Metabolomic Characterization of Cerebrospinal Fluid from Intracranial Bacterial Infection Pediatric Patients: A Pilot Study. Molecules 2021; 26:molecules26226871. [PMID: 34833963 PMCID: PMC8622478 DOI: 10.3390/molecules26226871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 01/20/2023] Open
Abstract
Intracranial bacterial infection remains a major cause of morbidity and mortality in neurosurgical cases. Metabolomic profiling of cerebrospinal fluid (CSF) holds great promise to gain insights into the pathogenesis of central neural system (CNS) bacterial infections. In this pilot study, we analyzed the metabolites in CSF of CNS infection patients and controls in a pseudo-targeted manner, aiming at elucidating the metabolic dysregulation in response to postoperative intracranial bacterial infection of pediatric cases. Untargeted analysis uncovered 597 metabolites, and screened out 206 differential metabolites in case of infection. Targeted verification and pathway analysis filtered out the glycolysis, amino acids metabolism and purine metabolism pathways as potential pathological pathways. These perturbed pathways are involved in the infection-induced oxidative stress and immune response. Characterization of the infection-induced metabolic changes can provide robust biomarkers of CNS bacterial infection for clinical diagnosis, novel pathways for pathological investigation, and new targets for treatment.
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Affiliation(s)
- Yiwen Wang
- Department of Chemistry, Shanghai Stomatological Hospital, Fudan University, Shanghai 200000, China;
| | - Yu Liu
- Department of Neurosurgery, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai 200062, China;
| | - Ruoping Chen
- Department of Pediatric Neurosurgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
- Correspondence: (R.C.); (L.Q.)
| | - Liang Qiao
- Department of Chemistry, Shanghai Stomatological Hospital, Fudan University, Shanghai 200000, China;
- Correspondence: (R.C.); (L.Q.)
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Kumar D, Pannu AK, Dhibar DP, Singh R, Kumari S. The epidemiology and clinical spectrum of infections of the central nervous system in adults in north India. Trop Doct 2020; 51:48-57. [PMID: 33019910 DOI: 10.1177/0049475520959905] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Infections of the central nervous system (CNS) are a leading cause of mortality in low- and middle-income countries. We studied the spectrum, aetiology and outcome of CNS infections in 401 consecutive patients aged ≥12 years admitted at the medical emergency centre of PGIMER, Chandigarh, India. An aetiological diagnosis was made in 365 (91.0%) patients, with 149 (40.8%) microbiologically confirmed cases. CNS tuberculosis was the most prevalent cause (51.5%), followed by viral meningoencephalitis (13.9%), community-acquired bacterial meningitis (9.7%), cryptococcal meningitis (6.2%), scrub typhus meningoencephalitis (1.7%), neurocysticercosis (1.7%) and fungal brain abscess (1.7%). Human immunodeficiency virus (11.0%) and diabetes mellitus (6.2%) remained the usual predisposing conditions. We found a mortality rate of 27.9%, highest in cases without an aetiology (64.5%). Tuberculosis remained the most common cause; however, an increasing number of scrub typhus, dengue, fungal infections and non-classical bacterial pathogens may indicate a change in the epidemiology of community-acquired CNS infections in India.
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Affiliation(s)
- Devender Kumar
- Resident, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Chandigarh, India
| | - Ashok Kumar Pannu
- Assistant Professor, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Chandigarh, India
| | - Deba Prasad Dhibar
- Assistant Professor, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Chandigarh, India
| | - Rajveer Singh
- Assistant Professor, Department of Neurology, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Chandigarh, India
| | - Savita Kumari
- Professor and Head, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Chandigarh, India
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10
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Marais S, Cresswell FV, Hamers RL, Te Brake LHM, Ganiem AR, Imran D, Bangdiwala A, Martyn E, Kasibante J, Kagimu E, Musubire A, Maharani K, Estiasari R, Kusumaningrum A, Kusumadjayanti N, Yunivita V, Naidoo K, Lessells R, Moosa Y, Svensson EM, Huppler Hullsiek K, Aarnoutse RE, Boulware DR, van Crevel R, Ruslami R, Meya DB. High dose oral rifampicin to improve survival from adult tuberculous meningitis: A randomised placebo-controlled double-blinded phase III trial (the HARVEST study). Wellcome Open Res 2020; 4:190. [PMID: 33083560 PMCID: PMC7542255 DOI: 10.12688/wellcomeopenres.15565.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2020] [Indexed: 12/18/2022] Open
Abstract
Background: Tuberculous meningitis (TBM), the most severe form of tuberculosis (TB), results in death or neurological disability in >50%, despite World Health Organisation recommended therapy. Current TBM regimen dosages are based on data from pulmonary TB alone. Evidence from recent phase II pharmacokinetic studies suggests that high dose rifampicin (R) administered intravenously or orally enhances central nervous system penetration and may reduce TBM associated mortality. We hypothesize that, among persons with TBM, high dose oral rifampicin (35 mg/kg) for 8 weeks will improve survival compared to standard of care (10 mg/kg), without excess adverse events. Protocol: We will perform a parallel group, randomised, placebo-controlled, double blind, phase III multicentre clinical trial comparing high dose oral rifampicin to standard of care. The trial will be conducted across five clinical sites in Uganda, South Africa and Indonesia. Participants are HIV-positive or negative adults with clinically suspected TBM, who will be randomised (1:1) to one of two arms: 35 mg/kg oral rifampicin daily for 8 weeks (in combination with standard dose isoniazid [H], pyrazinamide [Z] and ethambutol [E]) or standard of care (oral HRZE, containing 10 mg/kg/day rifampicin). The primary end-point is 6-month survival. Secondary end points are: i) 12-month survival ii) functional and neurocognitive outcomes and iii) safety and tolerability. Tertiary outcomes are: i) pharmacokinetic outcomes and ii) cost-effectiveness of the intervention. We will enrol 500 participants over 2.5 years, with follow-up continuing until 12 months post-enrolment. Discussion: Our best TBM treatment still results in unacceptably high mortality and morbidity. Strong evidence supports the increased cerebrospinal fluid penetration of high dose rifampicin, however conclusive evidence regarding survival benefit is lacking. This study will answer the important question of whether high dose oral rifampicin conveys a survival benefit in TBM in HIV-positive and -negative individuals from Africa and Asia. Trial registration: ISRCTN15668391 (17/06/2019)
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Affiliation(s)
- Suzaan Marais
- Department of Neurology, Inkosi Albert Luthuli Central Hospital, Durban, 4091, South Africa
| | - Fiona V Cresswell
- Infectious Diseases Institute, Mulago College of Health Sciences, Kampala, PO Box 22418, Uganda.,Clinical Research Department, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK.,MRC-UVRI, London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Raph L Hamers
- Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Lindsey H M Te Brake
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ahmad R Ganiem
- Department of Neurology, Faculty of Medicine, Universitas Padjadjaran/ Hasan Sadikin Hospital, Bandung, 40161, Indonesia.,Infectious Disease Research Centre, Faculty of Medicine, Universitas Padjadaran, Bandung, 40161, Indonesia
| | - Darma Imran
- Department of Neurology, Faculty of Medicine, Universitas Indonesia, Dr Cipto Mangukusumo Hospital, Jakarta, 10430, Indonesia
| | - Ananta Bangdiwala
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Emily Martyn
- Infectious Diseases Institute, Mulago College of Health Sciences, Kampala, PO Box 22418, Uganda
| | - John Kasibante
- Infectious Diseases Institute, Mulago College of Health Sciences, Kampala, PO Box 22418, Uganda
| | - Enock Kagimu
- Infectious Diseases Institute, Mulago College of Health Sciences, Kampala, PO Box 22418, Uganda
| | - Abdu Musubire
- Infectious Diseases Institute, Mulago College of Health Sciences, Kampala, PO Box 22418, Uganda
| | - Kartika Maharani
- Department of Neurology, Faculty of Medicine, Universitas Indonesia, Dr Cipto Mangukusumo Hospital, Jakarta, 10430, Indonesia
| | - Riwanti Estiasari
- Department of Neurology, Faculty of Medicine, Universitas Indonesia, Dr Cipto Mangukusumo Hospital, Jakarta, 10430, Indonesia
| | - Ardiana Kusumaningrum
- Department of Microbiology, Faculty of Medicine, Universitas Indonesia, Dr Cipto Mangukusumo Hospital, Jakarta, 10430, Indonesia
| | - Nadytia Kusumadjayanti
- Infectious Disease Research Centre, Faculty of Medicine, Universitas Padjadaran, Bandung, 40161, Indonesia
| | - Vycke Yunivita
- Department of Neurology, Faculty of Medicine, Universitas Padjadjaran/ Hasan Sadikin Hospital, Bandung, 40161, Indonesia.,Infectious Disease Research Centre, Faculty of Medicine, Universitas Padjadaran, Bandung, 40161, Indonesia
| | - Kogieleum Naidoo
- Centre for the AIDS programme of research in South Africa (CAPRISA), Doris Duke Medical Research Institute, Durban, 4041, South Africa.,CAPRISA-MRC HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu Natal, Durban, South Africa
| | - Richard Lessells
- Centre for the AIDS programme of research in South Africa (CAPRISA), Doris Duke Medical Research Institute, Durban, 4041, South Africa.,KwaZulu-Natal Research Innovation and Sequencing Platform, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, 4001, South Africa
| | - Yunus Moosa
- Department of Infectious Diseases, Division of Internal Medicine, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, 4013, South Africa
| | - Elin M Svensson
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands.,Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - Katherine Huppler Hullsiek
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Rob E Aarnoutse
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - David R Boulware
- Division of Medicine, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Reinout van Crevel
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Department of Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Rovina Ruslami
- Infectious Disease Research Centre, Faculty of Medicine, Universitas Padjadaran, Bandung, 40161, Indonesia.,Department of Biomedical Sciences, Division of Pharmacology and Therapy, Faculty of Medicine, Universitas Padjadjaran, Bandung, 40161, Indonesia
| | - David B Meya
- Infectious Diseases Institute, Mulago College of Health Sciences, Kampala, PO Box 22418, Uganda
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11
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Marais S, Cresswell FV, Hamers RL, te Brake LH, Ganiem AR, Imran D, Bangdiwala A, Martyn E, Kasibante J, Kagimu E, Musubire A, Maharani K, Estiasari R, Kusumaningrum A, Kusumadjayanti N, Yunivita V, Naidoo K, Lessells R, Moosa Y, Svensson EM, Huppler Hullsiek K, Aarnoutse RE, Boulware DR, van Crevel R, Ruslami R, Meya DB. High dose oral rifampicin to improve survival from adult tuberculous meningitis: A randomised placebo-controlled double-blinded phase III trial (the HARVEST study). Wellcome Open Res 2020; 4:190. [PMID: 33083560 PMCID: PMC7542255 DOI: 10.12688/wellcomeopenres.15565.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2020] [Indexed: 11/12/2023] Open
Abstract
Background: Tuberculous meningitis (TBM), the most severe form of tuberculosis (TB), results in death or neurological disability in >50%, despite World Health Organisation recommended therapy. Current TBM regimen dosages are based on data from pulmonary TB alone. Evidence from recent phase II pharmacokinetic studies suggests that high dose rifampicin (R) administered intravenously or orally enhances central nervous system penetration and may reduce TBM associated mortality. We hypothesize that, among persons with TBM, high dose oral rifampicin (35 mg/kg) for 8 weeks will improve survival compared to standard of care (10 mg/kg), without excess adverse events. Protocol: We will perform a parallel group, randomised, placebo-controlled, double blind, phase III multicentre clinical trial comparing high dose oral rifampicin to standard of care. The trial will be conducted across five clinical sites in Uganda, South Africa and Indonesia. Participants are HIV-positive or negative adults with clinically suspected TBM, who will be randomised (1:1) to one of two arms: 35 mg/kg oral rifampicin daily for 8 weeks (in combination with standard dose isoniazid [H], pyrazinamide [Z] and ethambutol [E]) or standard of care (oral HRZE, containing 10 mg/kg/day rifampicin). The primary end-point is 6-month survival. Secondary end points are: i) 12-month survival ii) functional and neurocognitive outcomes and iii) safety and tolerability. Tertiary outcomes are: i) pharmacokinetic outcomes and ii) cost-effectiveness of the intervention. We will enrol 500 participants over 2.5 years, with follow-up continuing until 12 months post-enrolment. Discussion: Our best TBM treatment still results in unacceptably high mortality and morbidity. Strong evidence supports the increased cerebrospinal fluid penetration of high dose rifampicin, however conclusive evidence regarding survival benefit is lacking. This study will answer the important question of whether high dose oral rifampicin conveys a survival benefit in TBM in HIV-positive and -negative individuals from Africa and Asia. Trial registration: ISRCTN15668391 (17/06/2019).
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Affiliation(s)
- Suzaan Marais
- Department of Neurology, Inkosi Albert Luthuli Central Hospital, Durban, 4091, South Africa
| | - Fiona V Cresswell
- Infectious Diseases Institute, Mulago College of Health Sciences, Kampala, PO Box 22418, Uganda
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
- MRC-UVRI, London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Raph L. Hamers
- Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Lindsey H.M. te Brake
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ahmad R. Ganiem
- Department of Neurology, Faculty of Medicine, Universitas Padjadjaran/ Hasan Sadikin Hospital, Bandung, 40161, Indonesia
- Infectious Disease Research Centre, Faculty of Medicine, Universitas Padjadaran, Bandung, 40161, Indonesia
| | - Darma Imran
- Department of Neurology, Faculty of Medicine, Universitas Indonesia, Dr Cipto Mangukusumo Hospital, Jakarta, 10430, Indonesia
| | - Ananta Bangdiwala
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Emily Martyn
- Infectious Diseases Institute, Mulago College of Health Sciences, Kampala, PO Box 22418, Uganda
| | - John Kasibante
- Infectious Diseases Institute, Mulago College of Health Sciences, Kampala, PO Box 22418, Uganda
| | - Enock Kagimu
- Infectious Diseases Institute, Mulago College of Health Sciences, Kampala, PO Box 22418, Uganda
| | - Abdu Musubire
- Infectious Diseases Institute, Mulago College of Health Sciences, Kampala, PO Box 22418, Uganda
| | - Kartika Maharani
- Department of Neurology, Faculty of Medicine, Universitas Indonesia, Dr Cipto Mangukusumo Hospital, Jakarta, 10430, Indonesia
| | - Riwanti Estiasari
- Department of Neurology, Faculty of Medicine, Universitas Indonesia, Dr Cipto Mangukusumo Hospital, Jakarta, 10430, Indonesia
| | - Ardiana Kusumaningrum
- Department of Microbiology, Faculty of Medicine, Universitas Indonesia, Dr Cipto Mangukusumo Hospital, Jakarta, 10430, Indonesia
| | - Nadytia Kusumadjayanti
- Infectious Disease Research Centre, Faculty of Medicine, Universitas Padjadaran, Bandung, 40161, Indonesia
| | - Vycke Yunivita
- Department of Neurology, Faculty of Medicine, Universitas Padjadjaran/ Hasan Sadikin Hospital, Bandung, 40161, Indonesia
- Infectious Disease Research Centre, Faculty of Medicine, Universitas Padjadaran, Bandung, 40161, Indonesia
| | - Kogieleum Naidoo
- Centre for the AIDS programme of research in South Africa (CAPRISA), Doris Duke Medical Research Institute, Durban, 4041, South Africa
- CAPRISA-MRC HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu Natal, Durban, South Africa
| | - Richard Lessells
- Centre for the AIDS programme of research in South Africa (CAPRISA), Doris Duke Medical Research Institute, Durban, 4041, South Africa
- KwaZulu-Natal Research Innovation and Sequencing Platform, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, 4001, South Africa
| | - Yunus Moosa
- Department of Infectious Diseases, Division of Internal Medicine, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, 4013, South Africa
| | - Elin M. Svensson
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - Katherine Huppler Hullsiek
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Rob E. Aarnoutse
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - David R. Boulware
- Division of Medicine, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Reinout van Crevel
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Rovina Ruslami
- Infectious Disease Research Centre, Faculty of Medicine, Universitas Padjadaran, Bandung, 40161, Indonesia
- Department of Biomedical Sciences, Division of Pharmacology and Therapy, Faculty of Medicine, Universitas Padjadjaran, Bandung, 40161, Indonesia
| | - David B. Meya
- Infectious Diseases Institute, Mulago College of Health Sciences, Kampala, PO Box 22418, Uganda
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12
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Salvador GLO, Basso ACN, Barbieri PP, Leitao CA, Teixeira BCA, Neto AC. Central nervous system and spinal cord tuberculosis: Revisiting an important disease. Clin Imaging 2020; 69:158-168. [PMID: 32853843 DOI: 10.1016/j.clinimag.2020.07.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/16/2020] [Accepted: 07/27/2020] [Indexed: 12/13/2022]
Abstract
Tuberculosis is a worldwide pandemic. Estimated that about 25% humans are colonized by Mycobacterium tuberculosis and about 1% are believed to develop the infection in the central nervous system (CNS-TB). Given the importance of this disease and its high levels of morbidity and mortality, it is imperative that every radiologist must be reminded of the most common findings of CNS-TB as there are several related differential diagnoses for this disease. The most common form CNS-TB is tuberculous meningitis (TBM), characterized mostly by basal meningitis, but infarction, hydrocephalus and tuberculomas could be present. Intracerebral tuberculosis is characterized by tuberculomas that can have different imaging features according to their stage. Vascular and spinal complications of tuberculosis are also reported. This review compiles the classic and unusual findings regarding CNS-TB together with new diagnostic scores in which neuroimaging have an important role.
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Affiliation(s)
- Gabriel L O Salvador
- Department of Diagnostic Radiology, Hospital de Clinicas, Federal University of Parana, Curitiba, Parana, Brazil.
| | - Ana C N Basso
- Department of Diagnostic Radiology, Hospital de Clinicas, Federal University of Parana, Curitiba, Parana, Brazil
| | - Poliana P Barbieri
- Department of Diagnostic Radiology, Hospital de Clinicas, Federal University of Parana, Curitiba, Parana, Brazil
| | - Cleverson A Leitao
- Department of Diagnostic Radiology, Hospital de Clinicas, Federal University of Parana, Curitiba, Parana, Brazil
| | - Bernardo C A Teixeira
- Department of Diagnostic Radiology, Hospital de Clinicas, Federal University of Parana, Curitiba, Parana, Brazil
| | - Arnolfo C Neto
- Department of Diagnostic Radiology, Hospital de Clinicas, Federal University of Parana, Curitiba, Parana, Brazil
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13
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Purwanto DS, Loho T, Tafroji W, Mangunatmadja I, Immanuel S, Timan IS, Yusra Y, Safari D. Isolation and identification of Streptococcus pneumoniae serotype 6B from a patient with bacterial meningitis infection in Jakarta, Indonesia. Access Microbiol 2020; 2:acmi000123. [PMID: 32974581 PMCID: PMC7494185 DOI: 10.1099/acmi.0.000123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 03/03/2020] [Indexed: 11/20/2022] Open
Abstract
CNS infection is a life-threatening condition in developing countries and Streptococcus pneumoniae has been reported as the most common cause of bacterial meningitis; however, there is limited data on pneumococcal meningitis in Indonesia. This cross-sectional study aimed to isolate and identity S. pneumoniae strains from cerebrospinal fluid (CSF) specimens collected as part of routine testing from patients with clinically diagnosed central nervous system infection at a national referral hospital in Jakarta, Indonesia in 2017. S. pneumoniae isolation and identification were performed using conventional culture and molecular tools. Antibiotic susceptibility patterns were monitored through minimum inhibitory concentration testing. From 147 CSF specimens, one S. pneumoniae strain was identified from a patient with bacterial meningitis symptoms. The isolate was serotype 6B (ST5661) and susceptible to 18 antimicrobial agents tested, including penicillin, tetracycline, and the macrolide group. Our data provide insights into the epidemiology of invasive pneumococcal disease in Indonesia.
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Affiliation(s)
- Diana Shintawati Purwanto
- Department of Clinical Pathology, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.,Department of Biochemistry, Faculty of Medicine Sam Ratulangi University, Manado, Indonesia
| | - Tonny Loho
- Department of Clinical Pathology, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Wisnu Tafroji
- Molecular Bacteriology Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Irawan Mangunatmadja
- Department of Child Health, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Suzanna Immanuel
- Department of Clinical Pathology, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Ina Susianti Timan
- Department of Clinical Pathology, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Yusra Yusra
- Department of Clinical Pathology, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Dodi Safari
- Molecular Bacteriology Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia
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14
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Imran D, Hill PC, McKnight J, van Crevel R. Establishing the cascade of care for patients with tuberculous meningitis. Wellcome Open Res 2019; 4:177. [PMID: 32118119 PMCID: PMC7008603 DOI: 10.12688/wellcomeopenres.15515.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2019] [Indexed: 10/13/2023] Open
Abstract
Meningitis is a relatively rare form of tuberculosis, but it carries a high mortality rate, reaching 50% in some settings, with higher rates among patients with HIV co-infection and those with drug-resistant disease. Most studies of tuberculosis meningitis (TBM) tend to focus on better diagnosis, drug treatment and supportive care for patients in hospital. However, there is significant variability in mortality between settings, which may be due to specific variation in the availability and quality of health care services, both prior to, during, and after hospitalization. Such variations have not been studied thoroughly, and we therefore present a theoretical framework that may help to identify where efforts should be focused in providing optimal services for TBM patients. As a first step, we propose an adjusted cascade of care for TBM and patient pathway studies that might help identify factors that account for losses and delays across the cascade. Many of the possible gaps in the TBM cascade are related to health systems factors; we have selected nine domains and provide relevant examples of systems factors for TBM for each of these domains that could be the basis for a health needs assessment to address such gaps. Finally, we suggest some immediate action that could be taken to help make improvements in services. Our theoretical framework will hopefully lead to more health system research and improved care for patients suffering from this most dangerous form of tuberculosis.
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Affiliation(s)
- Darma Imran
- Department of Neurology, Cipto Mangunkusumo Hospital, Faculty of Medicine University of Indonesia, Jakarta, Indonesia
| | - Philip C. Hill
- Center for International Health, University of Otago, Dunedin, New Zealand
| | - Jacob McKnight
- Oxford Health System Collaboration, Oxford University, Oxford, UK
| | - Reinout van Crevel
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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15
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Imran D, Hill PC, McKnight J, van Crevel R. Establishing the cascade of care for patients with tuberculous meningitis. Wellcome Open Res 2019; 4:177. [PMID: 32118119 PMCID: PMC7008603 DOI: 10.12688/wellcomeopenres.15515.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2019] [Indexed: 12/03/2022] Open
Abstract
Meningitis is a relatively rare form of tuberculosis, but it carries a high mortality rate, reaching 50% in some settings, with higher rates among patients with HIV co-infection and those with drug-resistant disease. Most studies of tuberculosis meningitis (TBM) tend to focus on better diagnosis, drug treatment and supportive care for patients in hospital. However, there is significant variability in mortality between settings, which may be due to specific variation in the availability and quality of health care services, both prior to, during, and after hospitalization. Such variations have not been studied thoroughly, and we therefore present a theoretical framework that may help to identify where efforts should be focused in providing optimal services for TBM patients. As a first step, we propose an adjusted cascade of care for TBM and patient pathway studies that might help identify factors that account for losses and delays across the cascade. Many of the possible gaps in the TBM cascade are related to health systems factors; we have selected nine domains and provide relevant examples of systems factors for TBM for each of these domains that could be the basis for a health needs assessment to address such gaps. Finally, we suggest some immediate action that could be taken to help make improvements in services. Our theoretical framework will hopefully lead to more health system research and improved care for patients suffering from this most dangerous form of tuberculosis.
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Affiliation(s)
- Darma Imran
- Department of Neurology, Cipto Mangunkusumo Hospital, Faculty of Medicine University of Indonesia, Jakarta, Indonesia
| | - Philip C Hill
- Center for International Health, University of Otago, Dunedin, New Zealand
| | - Jacob McKnight
- Oxford Health System Collaboration, Oxford University, Oxford, UK
| | - Reinout van Crevel
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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16
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Imran D, Satiti S, Sugianto P, Estiasari R, Maharani K, Pangeran D, Andini PW, Munir B, Mawuntu AHP, Susilawathi NM, Ritarwan K, Hartanto OS, Frida M, Ganiem AR, Gunawan D, Dian S, Sudewi AAR, van Crevel R. Barriers to diagnosis and management of CNS infections in Indonesia. Neurology 2019; 92:104-106. [PMID: 30617169 DOI: 10.1212/wnl.0000000000006732] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Darma Imran
- From the Faculty of Medicine (D.I., R.E., K.M., D.P., P.W.A.), Universitas Indonesia, Jakarta; Faculty of Medicine (S.S.), Universitas Gadjah Mada, Yogyakarta; Faculty of Medicine (P.S.), Universitas Airlangga, Surabaya; Faculty of Medicine (B.M.), Universitas Brawijaya, Malang; Faculty of Medicine (A.H.P.M.), Universitas Sam Ratulangi, Manado; Faculty of Medicine (N.M.S., A.A.R.S.), Universitas Udayana, Denpasar; Faculty of Medicine (K.R.), Universitas Sumatera Utara, Medan; Faculty of Medicine (O.S.H.), Universitas Negeri Sebelas Maret, Solo; Faculty of Medicine (M.F.), Universitas Andalas, Padang; Faculty of Medicine (A.R.G., D.G., S.D.), Universitas Padjadjaran, Bandung, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (R.v.C.), Radboud University Medical Center, Nijmegen, the Netherlands; and Centre for Tropical Medicine and Global Health (R.v.C.), Nuffield Department of Medicine, University of Oxford, UK.
| | - Sekar Satiti
- From the Faculty of Medicine (D.I., R.E., K.M., D.P., P.W.A.), Universitas Indonesia, Jakarta; Faculty of Medicine (S.S.), Universitas Gadjah Mada, Yogyakarta; Faculty of Medicine (P.S.), Universitas Airlangga, Surabaya; Faculty of Medicine (B.M.), Universitas Brawijaya, Malang; Faculty of Medicine (A.H.P.M.), Universitas Sam Ratulangi, Manado; Faculty of Medicine (N.M.S., A.A.R.S.), Universitas Udayana, Denpasar; Faculty of Medicine (K.R.), Universitas Sumatera Utara, Medan; Faculty of Medicine (O.S.H.), Universitas Negeri Sebelas Maret, Solo; Faculty of Medicine (M.F.), Universitas Andalas, Padang; Faculty of Medicine (A.R.G., D.G., S.D.), Universitas Padjadjaran, Bandung, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (R.v.C.), Radboud University Medical Center, Nijmegen, the Netherlands; and Centre for Tropical Medicine and Global Health (R.v.C.), Nuffield Department of Medicine, University of Oxford, UK
| | - Paulus Sugianto
- From the Faculty of Medicine (D.I., R.E., K.M., D.P., P.W.A.), Universitas Indonesia, Jakarta; Faculty of Medicine (S.S.), Universitas Gadjah Mada, Yogyakarta; Faculty of Medicine (P.S.), Universitas Airlangga, Surabaya; Faculty of Medicine (B.M.), Universitas Brawijaya, Malang; Faculty of Medicine (A.H.P.M.), Universitas Sam Ratulangi, Manado; Faculty of Medicine (N.M.S., A.A.R.S.), Universitas Udayana, Denpasar; Faculty of Medicine (K.R.), Universitas Sumatera Utara, Medan; Faculty of Medicine (O.S.H.), Universitas Negeri Sebelas Maret, Solo; Faculty of Medicine (M.F.), Universitas Andalas, Padang; Faculty of Medicine (A.R.G., D.G., S.D.), Universitas Padjadjaran, Bandung, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (R.v.C.), Radboud University Medical Center, Nijmegen, the Netherlands; and Centre for Tropical Medicine and Global Health (R.v.C.), Nuffield Department of Medicine, University of Oxford, UK
| | - Riwanti Estiasari
- From the Faculty of Medicine (D.I., R.E., K.M., D.P., P.W.A.), Universitas Indonesia, Jakarta; Faculty of Medicine (S.S.), Universitas Gadjah Mada, Yogyakarta; Faculty of Medicine (P.S.), Universitas Airlangga, Surabaya; Faculty of Medicine (B.M.), Universitas Brawijaya, Malang; Faculty of Medicine (A.H.P.M.), Universitas Sam Ratulangi, Manado; Faculty of Medicine (N.M.S., A.A.R.S.), Universitas Udayana, Denpasar; Faculty of Medicine (K.R.), Universitas Sumatera Utara, Medan; Faculty of Medicine (O.S.H.), Universitas Negeri Sebelas Maret, Solo; Faculty of Medicine (M.F.), Universitas Andalas, Padang; Faculty of Medicine (A.R.G., D.G., S.D.), Universitas Padjadjaran, Bandung, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (R.v.C.), Radboud University Medical Center, Nijmegen, the Netherlands; and Centre for Tropical Medicine and Global Health (R.v.C.), Nuffield Department of Medicine, University of Oxford, UK
| | - Kartika Maharani
- From the Faculty of Medicine (D.I., R.E., K.M., D.P., P.W.A.), Universitas Indonesia, Jakarta; Faculty of Medicine (S.S.), Universitas Gadjah Mada, Yogyakarta; Faculty of Medicine (P.S.), Universitas Airlangga, Surabaya; Faculty of Medicine (B.M.), Universitas Brawijaya, Malang; Faculty of Medicine (A.H.P.M.), Universitas Sam Ratulangi, Manado; Faculty of Medicine (N.M.S., A.A.R.S.), Universitas Udayana, Denpasar; Faculty of Medicine (K.R.), Universitas Sumatera Utara, Medan; Faculty of Medicine (O.S.H.), Universitas Negeri Sebelas Maret, Solo; Faculty of Medicine (M.F.), Universitas Andalas, Padang; Faculty of Medicine (A.R.G., D.G., S.D.), Universitas Padjadjaran, Bandung, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (R.v.C.), Radboud University Medical Center, Nijmegen, the Netherlands; and Centre for Tropical Medicine and Global Health (R.v.C.), Nuffield Department of Medicine, University of Oxford, UK
| | - David Pangeran
- From the Faculty of Medicine (D.I., R.E., K.M., D.P., P.W.A.), Universitas Indonesia, Jakarta; Faculty of Medicine (S.S.), Universitas Gadjah Mada, Yogyakarta; Faculty of Medicine (P.S.), Universitas Airlangga, Surabaya; Faculty of Medicine (B.M.), Universitas Brawijaya, Malang; Faculty of Medicine (A.H.P.M.), Universitas Sam Ratulangi, Manado; Faculty of Medicine (N.M.S., A.A.R.S.), Universitas Udayana, Denpasar; Faculty of Medicine (K.R.), Universitas Sumatera Utara, Medan; Faculty of Medicine (O.S.H.), Universitas Negeri Sebelas Maret, Solo; Faculty of Medicine (M.F.), Universitas Andalas, Padang; Faculty of Medicine (A.R.G., D.G., S.D.), Universitas Padjadjaran, Bandung, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (R.v.C.), Radboud University Medical Center, Nijmegen, the Netherlands; and Centre for Tropical Medicine and Global Health (R.v.C.), Nuffield Department of Medicine, University of Oxford, UK
| | - Putri Widya Andini
- From the Faculty of Medicine (D.I., R.E., K.M., D.P., P.W.A.), Universitas Indonesia, Jakarta; Faculty of Medicine (S.S.), Universitas Gadjah Mada, Yogyakarta; Faculty of Medicine (P.S.), Universitas Airlangga, Surabaya; Faculty of Medicine (B.M.), Universitas Brawijaya, Malang; Faculty of Medicine (A.H.P.M.), Universitas Sam Ratulangi, Manado; Faculty of Medicine (N.M.S., A.A.R.S.), Universitas Udayana, Denpasar; Faculty of Medicine (K.R.), Universitas Sumatera Utara, Medan; Faculty of Medicine (O.S.H.), Universitas Negeri Sebelas Maret, Solo; Faculty of Medicine (M.F.), Universitas Andalas, Padang; Faculty of Medicine (A.R.G., D.G., S.D.), Universitas Padjadjaran, Bandung, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (R.v.C.), Radboud University Medical Center, Nijmegen, the Netherlands; and Centre for Tropical Medicine and Global Health (R.v.C.), Nuffield Department of Medicine, University of Oxford, UK
| | - Badrul Munir
- From the Faculty of Medicine (D.I., R.E., K.M., D.P., P.W.A.), Universitas Indonesia, Jakarta; Faculty of Medicine (S.S.), Universitas Gadjah Mada, Yogyakarta; Faculty of Medicine (P.S.), Universitas Airlangga, Surabaya; Faculty of Medicine (B.M.), Universitas Brawijaya, Malang; Faculty of Medicine (A.H.P.M.), Universitas Sam Ratulangi, Manado; Faculty of Medicine (N.M.S., A.A.R.S.), Universitas Udayana, Denpasar; Faculty of Medicine (K.R.), Universitas Sumatera Utara, Medan; Faculty of Medicine (O.S.H.), Universitas Negeri Sebelas Maret, Solo; Faculty of Medicine (M.F.), Universitas Andalas, Padang; Faculty of Medicine (A.R.G., D.G., S.D.), Universitas Padjadjaran, Bandung, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (R.v.C.), Radboud University Medical Center, Nijmegen, the Netherlands; and Centre for Tropical Medicine and Global Health (R.v.C.), Nuffield Department of Medicine, University of Oxford, UK
| | - Arthur H P Mawuntu
- From the Faculty of Medicine (D.I., R.E., K.M., D.P., P.W.A.), Universitas Indonesia, Jakarta; Faculty of Medicine (S.S.), Universitas Gadjah Mada, Yogyakarta; Faculty of Medicine (P.S.), Universitas Airlangga, Surabaya; Faculty of Medicine (B.M.), Universitas Brawijaya, Malang; Faculty of Medicine (A.H.P.M.), Universitas Sam Ratulangi, Manado; Faculty of Medicine (N.M.S., A.A.R.S.), Universitas Udayana, Denpasar; Faculty of Medicine (K.R.), Universitas Sumatera Utara, Medan; Faculty of Medicine (O.S.H.), Universitas Negeri Sebelas Maret, Solo; Faculty of Medicine (M.F.), Universitas Andalas, Padang; Faculty of Medicine (A.R.G., D.G., S.D.), Universitas Padjadjaran, Bandung, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (R.v.C.), Radboud University Medical Center, Nijmegen, the Netherlands; and Centre for Tropical Medicine and Global Health (R.v.C.), Nuffield Department of Medicine, University of Oxford, UK
| | - Ni Made Susilawathi
- From the Faculty of Medicine (D.I., R.E., K.M., D.P., P.W.A.), Universitas Indonesia, Jakarta; Faculty of Medicine (S.S.), Universitas Gadjah Mada, Yogyakarta; Faculty of Medicine (P.S.), Universitas Airlangga, Surabaya; Faculty of Medicine (B.M.), Universitas Brawijaya, Malang; Faculty of Medicine (A.H.P.M.), Universitas Sam Ratulangi, Manado; Faculty of Medicine (N.M.S., A.A.R.S.), Universitas Udayana, Denpasar; Faculty of Medicine (K.R.), Universitas Sumatera Utara, Medan; Faculty of Medicine (O.S.H.), Universitas Negeri Sebelas Maret, Solo; Faculty of Medicine (M.F.), Universitas Andalas, Padang; Faculty of Medicine (A.R.G., D.G., S.D.), Universitas Padjadjaran, Bandung, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (R.v.C.), Radboud University Medical Center, Nijmegen, the Netherlands; and Centre for Tropical Medicine and Global Health (R.v.C.), Nuffield Department of Medicine, University of Oxford, UK
| | - Kiking Ritarwan
- From the Faculty of Medicine (D.I., R.E., K.M., D.P., P.W.A.), Universitas Indonesia, Jakarta; Faculty of Medicine (S.S.), Universitas Gadjah Mada, Yogyakarta; Faculty of Medicine (P.S.), Universitas Airlangga, Surabaya; Faculty of Medicine (B.M.), Universitas Brawijaya, Malang; Faculty of Medicine (A.H.P.M.), Universitas Sam Ratulangi, Manado; Faculty of Medicine (N.M.S., A.A.R.S.), Universitas Udayana, Denpasar; Faculty of Medicine (K.R.), Universitas Sumatera Utara, Medan; Faculty of Medicine (O.S.H.), Universitas Negeri Sebelas Maret, Solo; Faculty of Medicine (M.F.), Universitas Andalas, Padang; Faculty of Medicine (A.R.G., D.G., S.D.), Universitas Padjadjaran, Bandung, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (R.v.C.), Radboud University Medical Center, Nijmegen, the Netherlands; and Centre for Tropical Medicine and Global Health (R.v.C.), Nuffield Department of Medicine, University of Oxford, UK
| | - O S Hartanto
- From the Faculty of Medicine (D.I., R.E., K.M., D.P., P.W.A.), Universitas Indonesia, Jakarta; Faculty of Medicine (S.S.), Universitas Gadjah Mada, Yogyakarta; Faculty of Medicine (P.S.), Universitas Airlangga, Surabaya; Faculty of Medicine (B.M.), Universitas Brawijaya, Malang; Faculty of Medicine (A.H.P.M.), Universitas Sam Ratulangi, Manado; Faculty of Medicine (N.M.S., A.A.R.S.), Universitas Udayana, Denpasar; Faculty of Medicine (K.R.), Universitas Sumatera Utara, Medan; Faculty of Medicine (O.S.H.), Universitas Negeri Sebelas Maret, Solo; Faculty of Medicine (M.F.), Universitas Andalas, Padang; Faculty of Medicine (A.R.G., D.G., S.D.), Universitas Padjadjaran, Bandung, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (R.v.C.), Radboud University Medical Center, Nijmegen, the Netherlands; and Centre for Tropical Medicine and Global Health (R.v.C.), Nuffield Department of Medicine, University of Oxford, UK
| | - Meity Frida
- From the Faculty of Medicine (D.I., R.E., K.M., D.P., P.W.A.), Universitas Indonesia, Jakarta; Faculty of Medicine (S.S.), Universitas Gadjah Mada, Yogyakarta; Faculty of Medicine (P.S.), Universitas Airlangga, Surabaya; Faculty of Medicine (B.M.), Universitas Brawijaya, Malang; Faculty of Medicine (A.H.P.M.), Universitas Sam Ratulangi, Manado; Faculty of Medicine (N.M.S., A.A.R.S.), Universitas Udayana, Denpasar; Faculty of Medicine (K.R.), Universitas Sumatera Utara, Medan; Faculty of Medicine (O.S.H.), Universitas Negeri Sebelas Maret, Solo; Faculty of Medicine (M.F.), Universitas Andalas, Padang; Faculty of Medicine (A.R.G., D.G., S.D.), Universitas Padjadjaran, Bandung, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (R.v.C.), Radboud University Medical Center, Nijmegen, the Netherlands; and Centre for Tropical Medicine and Global Health (R.v.C.), Nuffield Department of Medicine, University of Oxford, UK
| | - Ahmad Rizal Ganiem
- From the Faculty of Medicine (D.I., R.E., K.M., D.P., P.W.A.), Universitas Indonesia, Jakarta; Faculty of Medicine (S.S.), Universitas Gadjah Mada, Yogyakarta; Faculty of Medicine (P.S.), Universitas Airlangga, Surabaya; Faculty of Medicine (B.M.), Universitas Brawijaya, Malang; Faculty of Medicine (A.H.P.M.), Universitas Sam Ratulangi, Manado; Faculty of Medicine (N.M.S., A.A.R.S.), Universitas Udayana, Denpasar; Faculty of Medicine (K.R.), Universitas Sumatera Utara, Medan; Faculty of Medicine (O.S.H.), Universitas Negeri Sebelas Maret, Solo; Faculty of Medicine (M.F.), Universitas Andalas, Padang; Faculty of Medicine (A.R.G., D.G., S.D.), Universitas Padjadjaran, Bandung, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (R.v.C.), Radboud University Medical Center, Nijmegen, the Netherlands; and Centre for Tropical Medicine and Global Health (R.v.C.), Nuffield Department of Medicine, University of Oxford, UK
| | - Dede Gunawan
- From the Faculty of Medicine (D.I., R.E., K.M., D.P., P.W.A.), Universitas Indonesia, Jakarta; Faculty of Medicine (S.S.), Universitas Gadjah Mada, Yogyakarta; Faculty of Medicine (P.S.), Universitas Airlangga, Surabaya; Faculty of Medicine (B.M.), Universitas Brawijaya, Malang; Faculty of Medicine (A.H.P.M.), Universitas Sam Ratulangi, Manado; Faculty of Medicine (N.M.S., A.A.R.S.), Universitas Udayana, Denpasar; Faculty of Medicine (K.R.), Universitas Sumatera Utara, Medan; Faculty of Medicine (O.S.H.), Universitas Negeri Sebelas Maret, Solo; Faculty of Medicine (M.F.), Universitas Andalas, Padang; Faculty of Medicine (A.R.G., D.G., S.D.), Universitas Padjadjaran, Bandung, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (R.v.C.), Radboud University Medical Center, Nijmegen, the Netherlands; and Centre for Tropical Medicine and Global Health (R.v.C.), Nuffield Department of Medicine, University of Oxford, UK
| | - Sofiati Dian
- From the Faculty of Medicine (D.I., R.E., K.M., D.P., P.W.A.), Universitas Indonesia, Jakarta; Faculty of Medicine (S.S.), Universitas Gadjah Mada, Yogyakarta; Faculty of Medicine (P.S.), Universitas Airlangga, Surabaya; Faculty of Medicine (B.M.), Universitas Brawijaya, Malang; Faculty of Medicine (A.H.P.M.), Universitas Sam Ratulangi, Manado; Faculty of Medicine (N.M.S., A.A.R.S.), Universitas Udayana, Denpasar; Faculty of Medicine (K.R.), Universitas Sumatera Utara, Medan; Faculty of Medicine (O.S.H.), Universitas Negeri Sebelas Maret, Solo; Faculty of Medicine (M.F.), Universitas Andalas, Padang; Faculty of Medicine (A.R.G., D.G., S.D.), Universitas Padjadjaran, Bandung, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (R.v.C.), Radboud University Medical Center, Nijmegen, the Netherlands; and Centre for Tropical Medicine and Global Health (R.v.C.), Nuffield Department of Medicine, University of Oxford, UK
| | - A A R Sudewi
- From the Faculty of Medicine (D.I., R.E., K.M., D.P., P.W.A.), Universitas Indonesia, Jakarta; Faculty of Medicine (S.S.), Universitas Gadjah Mada, Yogyakarta; Faculty of Medicine (P.S.), Universitas Airlangga, Surabaya; Faculty of Medicine (B.M.), Universitas Brawijaya, Malang; Faculty of Medicine (A.H.P.M.), Universitas Sam Ratulangi, Manado; Faculty of Medicine (N.M.S., A.A.R.S.), Universitas Udayana, Denpasar; Faculty of Medicine (K.R.), Universitas Sumatera Utara, Medan; Faculty of Medicine (O.S.H.), Universitas Negeri Sebelas Maret, Solo; Faculty of Medicine (M.F.), Universitas Andalas, Padang; Faculty of Medicine (A.R.G., D.G., S.D.), Universitas Padjadjaran, Bandung, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (R.v.C.), Radboud University Medical Center, Nijmegen, the Netherlands; and Centre for Tropical Medicine and Global Health (R.v.C.), Nuffield Department of Medicine, University of Oxford, UK
| | - Reinout van Crevel
- From the Faculty of Medicine (D.I., R.E., K.M., D.P., P.W.A.), Universitas Indonesia, Jakarta; Faculty of Medicine (S.S.), Universitas Gadjah Mada, Yogyakarta; Faculty of Medicine (P.S.), Universitas Airlangga, Surabaya; Faculty of Medicine (B.M.), Universitas Brawijaya, Malang; Faculty of Medicine (A.H.P.M.), Universitas Sam Ratulangi, Manado; Faculty of Medicine (N.M.S., A.A.R.S.), Universitas Udayana, Denpasar; Faculty of Medicine (K.R.), Universitas Sumatera Utara, Medan; Faculty of Medicine (O.S.H.), Universitas Negeri Sebelas Maret, Solo; Faculty of Medicine (M.F.), Universitas Andalas, Padang; Faculty of Medicine (A.R.G., D.G., S.D.), Universitas Padjadjaran, Bandung, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (R.v.C.), Radboud University Medical Center, Nijmegen, the Netherlands; and Centre for Tropical Medicine and Global Health (R.v.C.), Nuffield Department of Medicine, University of Oxford, UK
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17
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Donovan J, Figaji A, Imran D, Phu NH, Rohlwink U, Thwaites GE. The neurocritical care of tuberculous meningitis. Lancet Neurol 2019; 18:771-783. [PMID: 31109897 DOI: 10.1016/s1474-4422(19)30154-1] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 02/28/2019] [Accepted: 03/05/2019] [Indexed: 12/16/2022]
Abstract
Tuberculous meningitis is the most severe form of tuberculosis and often causes critical illness with high mortality. Two primary management objectives are reducing intracranial pressure, and optimising cerebral perfusion, while killing the bacteria and controlling intracerebral inflammation. However, the evidence base guiding the care of critically ill patients with tuberculous meningitis is poor and many patients do not have access to neurocritical care units. Invasive intracranial pressure monitoring is often unavailable and although new non-invasive monitoring techniques show promise, further evidence for their use is required. Optimal management regimens of neurological complications (eg, hydrocephalus and paradoxical reactions) and of hyponatraemia, which frequently accompanies tuberculous meningitis, remain to be elucidated. Advances in the field of tuberculous meningitis predominantly focus on diagnosis, inflammatory processes, and antituberculosis chemotherapy. However, clinical trials are required to provide robust evidence guiding the most effective supportive, therapeutic, and neurosurgical interventions for tuberculous meningitis that will improve morbidity and mortality.
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Affiliation(s)
- Joseph Donovan
- Oxford University Clinical Research Unit, Centre for Tropical Medicine, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Anthony Figaji
- Division of Neurosurgery and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Darma Imran
- Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Nguyen Hoan Phu
- Oxford University Clinical Research Unit, Centre for Tropical Medicine, Ho Chi Minh City, Vietnam; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Ursula Rohlwink
- Division of Neurosurgery and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Guy E Thwaites
- Oxford University Clinical Research Unit, Centre for Tropical Medicine, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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18
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Herpes Simplex Virus and Tuberculosis-Associated Encephalitis in Northeast of Iran. Jundishapur J Microbiol 2019. [DOI: 10.5812/jjm.83452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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