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Doi A, Hasuike T, Shindo T, Nishioka H. Elevation of CSF adenosine deaminase in HIV patient with meningitis from retroviral rebound syndrome, a case report. Int J Infect Dis 2020; 98:297-298. [PMID: 32562847 DOI: 10.1016/j.ijid.2020.06.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/10/2020] [Accepted: 06/13/2020] [Indexed: 11/18/2022] Open
Abstract
Adenosine deaminase (ADA) in cerebrospinal fluid (CSF) is considered to be a useful biomarker in differentiating tuberculous meningitis (TBM) from other meningitis in non-HIV patients. However, its specificity decreases in patients with HIV, and other diseases such as cytomegalovirus encephalitis, toxoplasmosis or meningeal lymphomatosis can also elevate ADA in CSF. We here report a rare case of retroviral rebound syndrome in a HIV patient, whose ADA in CSF was elevated.
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Affiliation(s)
- Asako Doi
- Department of Infectious Diseases, Kobe City Medical Center General Hospital, Japan; Department of General Internal Medicine, Kobe City Medical Center General Hospital, Japan.
| | - Toshikazu Hasuike
- Department of Infectious Diseases, Kobe City Medical Center General Hospital, Japan; Department of General Internal Medicine, Kobe City Medical Center General Hospital, Japan
| | - Tatsuya Shindo
- Department of General Internal Medicine, Kobe City Medical Center General Hospital, Japan
| | - Hiroaki Nishioka
- Department of Infectious Diseases, Kobe City Medical Center General Hospital, Japan; Department of General Internal Medicine, Kobe City Medical Center General Hospital, Japan
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Meregildo Rodriguez ED, Chiroque MV, Rodriguez Llanos JR, Sánchez Carrillo HC, Vílchez Rivera S, Delgado Sánchez MC. First case report of tuberculous meningitis secondary to endometrial tuberculosis following a clandestine abortion. Infez Med 2020; 28:82-86. [PMID: 32172265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Tuberculous meningitis (TBM) is a medical emergency: it is the most severe, lethal and disabling clinical form of tuberculosis. We report the case of a 44-year-old woman who had undergone a clandestine abortion six weeks before admission. One week later, she had abnormal vaginal discharge. Three weeks prior to admission, headache, hyperpyrexia and mental alteration were added. At admission, a transvaginal ultrasound showed abnormalities of the uterine cavity. Sepsis and endometritis were diagnosed, and a hysterectomy was scheduled. During preoperative evaluation, meningeal signs were found. The first lumbar puncture (LP) showed a lymphomononuclear pleocytosis, hypoglycorrhachia and hyperproteinorrachia. After five days treatment with ceftriaxone, vancomycin and dexamethasone, only partial recovery occurred. A second LP showed AFB and PCR confirmed Mycobacterium tuberculosis. The histopathology of endometrial biopsy confirmed endometrial tuberculosis. Therapeutic response to anti-tuberculous treatment and corticosteroids was excellent. No other cause of immunosuppression apart from pregnancy was found. To the best of our knowledge, this is the first report of TBM secondary to endometrial tuberculosis and highlights an unusual clinical scenario in which severe and disseminated forms of TB could be present. TBM during and after pregnancy is rare, but compared with TBM in non-pregnant women, it has a poorer prognosis. Early diagnosis and treatment can be lifesaving in this life-threatening disease.
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Affiliation(s)
- Edinson Dante Meregildo Rodriguez
- Universidad Señor de Sipán, Chiclayo, Lambayeque, Peru; Department of Internal Medicine, Hospital Regional Lambayeque, Chiclayo, Peru
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Bang ND, Caws M, Truc TT, Duong TN, Dung NH, Ha DTM, Thwaites GE, Heemskerk D, Tarning J, Merson L, Van Toi P, Farrar JJ, Wolbers M, Pouplin T, Day JN. Clinical presentations, diagnosis, mortality and prognostic markers of tuberculous meningitis in Vietnamese children: a prospective descriptive study. BMC Infect Dis 2016; 16:573. [PMID: 27756256 PMCID: PMC5070308 DOI: 10.1186/s12879-016-1923-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 10/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tuberculous meningitis in adults is well characterized in Vietnam, but there are no data on the disease in children. We present a prospective descriptive study of Vietnamese children with TBM to define the presentation, course and characteristics associated with poor outcome. METHODS A prospective descriptive study of 100 consecutively admitted children with TBM at Pham Ngoc Thach Hospital, Ho Chi Minh City. Cox and logistic regression were used to identify factors associated with risk of death and a combined endpoint of death or disability at treatment completion. RESULTS The study enrolled from October 2009 to March 2011. Median age was 32.5 months; sex distribution was equal. Median duration of symptoms was 18.5 days and time from admission to treatment initiation was 11 days. Fifteen of 100 children died, 4 were lost to follow-up, and 27/81 (33 %) of survivors had intermediate or severe disability upon treatment completion. Microbiological confirmation of disease was made in 6 %. Baseline characteristics associated with death included convulsions (HR 3.46, 95CI 1.19-10.13, p = 0.02), decreased consciousness (HR 22.9, 95CI 3.01-174.3, p < 0.001), focal neurological deficits (HR 15.7, 95CI 1.67-2075, p = 0.01), Blantyre Coma Score (HR 3.75, 95CI 0.99-14.2, p < 0.001) and CSF protein, lactate and glucose levels. Neck stiffness, MRC grade (children aged >5 years) and hydrocephalus were also associated with the combined endpoint of death or disability. CONCLUSIONS Tuberculous meningitis in Vietnamese children has significant mortality and morbidity. There is significant delay in diagnosis; interventions that increase the speed of diagnosis and treatment initiation are likely to improve outcomes.
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Affiliation(s)
- Nguyen Duc Bang
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam
- Pham Ngoc Thach Hospital, 120 Hung Vuong, Quan 5, Ho Chi Minh City, Vietnam
| | - Maxine Caws
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, L3 5QA Liverpool, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Old Road campus, Roosevelt Drive, Oxford, UK
| | - Thai Thanh Truc
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam
| | - Tran Ngoc Duong
- Pham Ngoc Thach Hospital, 120 Hung Vuong, Quan 5, Ho Chi Minh City, Vietnam
| | - Nguyen Huy Dung
- Pham Ngoc Thach Hospital, 120 Hung Vuong, Quan 5, Ho Chi Minh City, Vietnam
| | - Dang Thi Minh Ha
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam
- Pham Ngoc Thach Hospital, 120 Hung Vuong, Quan 5, Ho Chi Minh City, Vietnam
| | - Guy E. Thwaites
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Old Road campus, Roosevelt Drive, Oxford, UK
| | - Doortje Heemskerk
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Old Road campus, Roosevelt Drive, Oxford, UK
| | - Joel Tarning
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Old Road campus, Roosevelt Drive, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, 420/6 Ratchawithi Rd., Bangkok, Thailand
| | - Laura Merson
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Old Road campus, Roosevelt Drive, Oxford, UK
| | - Pham Van Toi
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Old Road campus, Roosevelt Drive, Oxford, UK
| | - Jeremy J. Farrar
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Old Road campus, Roosevelt Drive, Oxford, UK
| | - Marcel Wolbers
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Old Road campus, Roosevelt Drive, Oxford, UK
| | - Thomas Pouplin
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Old Road campus, Roosevelt Drive, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, 420/6 Ratchawithi Rd., Bangkok, Thailand
| | - Jeremy N. Day
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Old Road campus, Roosevelt Drive, Oxford, UK
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Castro Márquez C, Castro Laria L, Argüelles Arias F, Herrerías JM. Residual hydrocephalus after tuberculous meningitis in a patient with biological therapy. Inflamm Bowel Dis 2011; 17:E33-4. [PMID: 21351212 DOI: 10.1002/ibd.21664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Accepted: 01/05/2011] [Indexed: 12/19/2022]
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Galimi R. Extrapulmonary tuberculosis: tuberculous meningitis new developments. Eur Rev Med Pharmacol Sci 2011; 15:365-386. [PMID: 21608431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Tuberculosis (TB) can involve any organ system in the body. Extrapulmonary involvement can occur in isolation or along with a pulmonary focus as in the case of patients with disseminated tuberculosis. Tuberculosis meningitis (TBM) is the most severe form of extrapulmonary tuberculosis. TBM a medical emergency, is still a major cause of serious illness in many parts of the world. TBM remains difficult to diagnose, and it is usually due to hematogenous dissemination of the tubercle bacillus. The exact incidence and prevalence are not known. The clinical spectrum is broad and may be non-specific making early diagnosis difficult. Improved outcome requires early recognition and treatment of these conditions. Clinical features included fever for more than 7 days, headache, or neck stiffness. While TBM is a disease of childhood, tuberculomas and spinal tuberculosis are invariably an adult manifestation. In HIV infection, TB is often atypical in presentation, frequently causing extrapulmonary disease, and patients have a high incidence of TBM. Clinical response to antituberculous therapy in all forms of neurotuberculosis is excellent if the diagnosis is made early before irreversible neurological deficit is established. Diagnosis is based on the characteristic clinical picture, neuroimaging abnormalities, cerebrospinal fluid changes and the response to anti-tuberculosis drugs. Diagnosis is best made with lumbar puncture and examination of the cerebrospinal fluid (CSF). Suspect TBM if there is a CSF leucocytosis (predominantly lymphocytes), the CSF protein is raised, and the CSF plasma glucose is <50%. Rapid techniques based on nucleic acid amplification such as PCR are more sensitive and specific as they attempt to detect specific DNA sequences of the organism. The hallmark pathological processes are meningeal inflammation, basal exudates, vasculitis and hydrocephalus. Treatment delay is strongly associated with death and empirical anti-tuberculosis therapy should be started promptly in all patients in whom the diagnosis of TBM is suspected. Corticosteroids reduce the number of deaths. Development of an effective vaccine against tuberculosis hinges on an improved understanding of the human immune response to Mycobacterium tuberculosis (Mtb). The emergence of drug resistant tuberculosis poses a serious threat to the control of this pathogen, and the development of drugs that are active against the resistant strains is vital. Further research into the epidemiology, immune mechanisms, diagnosis, treatment, and prevention of TBM is urgently needed.
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Affiliation(s)
- R Galimi
- Department of Neurology, Local Health Unit of Valtellina and Valchiavenna, Sondalo Hospital, Sondrio, Italy.
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6
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Ozkok A, Cagatay A, Topkarci Z, Baykal C. Lupus vulgaris preceding tuberculous meningitis. Intern Med 2011; 50:171-2. [PMID: 21245648 DOI: 10.2169/internalmedicine.50.4608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Abdullah Ozkok
- Department of Internal Medicine, Istanbul University, Istanbul, Turkey.
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Vidal JE, de Oliveira ACP, Hernández AV. CD4+ T-cell count and cerebrospinal fluid findings in HIV-infected patients with tuberculous meningitis. Int J Tuberc Lung Dis 2010; 14:1496-1497. [PMID: 20937194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
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Abstract
An unusual case of tubercular granulomatous hypophysitis is reported. A sellar mass diagnosed as pituitary adenoma in MRI, showed non-caseating granulomas, glandular destruction and fibrosis in histology. Stain for acid-fast bacilli (AFB) were negative and the case was misdiagnosed as Idiopathic Granulomatous hypophysitis. The patient came back 2 weeks after trans-sphenoidal endoscopic resection with meningitis. CSF showed mixed pleocytosis. PCR for Mycobacterium tuberculosis was positive. The case is reported to highlight the need to maintain a high degree of suspicion for tuberculosis in any form of granulomatous hypophysitis, with or without caseous necrosis, in regions endemic for tuberculosis to prevent subsequent complications.
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Affiliation(s)
- Nuzhat Husain
- Department of Pathology, King George's Medical University, Lucknow, 226003, India.
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9
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Etienne M, Noble JM. Multiple parenchymal tuberculomas without tuberculous meningitis. ACTA ACUST UNITED AC 2007; 64:1045-7. [PMID: 17620499 DOI: 10.1001/archneur.64.7.1045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Mill Etienne
- The Neurological Institute of New York, Columbia University Medical Center, 710 W 168th St, New York, NY 10032, USA
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10
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Tsuyusaki J, Sasaki Y, Yamagishi F, Yagi T, Hashimoto T, Bekku R, Yamanaka M. [Case of disseminated tuberculosis complicated with tuberculous meningitis while investigating an abdominal lymphadenopathy]. Kekkaku 2006; 81:667-71. [PMID: 17154045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
In February 2005, a 33-year-old man visited A hospital complaining of fever. The blood screening test revealed the liver dysfunction, then computed tomography showed swelling of abdominal lymph nodes. In April, headache and disorientation appeared. He was diagnosed as disseminated tuberculosis and tuberculous meningitis based on chest X-ray and computed tomography findings and examination of cerebrospinal fluid. After admission to our hospital, anti-tuberculous drugs were prescribed, but the cerebral infarction happened. The disturbance of consciousness and the left half of his body paralysis appeared. They did not improve and hydrocephalus was complicated in August, though he was treated by steroids. He needed all helps because of the left half of his body paralysis and an advanced sequelae was left. It was thought that the abdominal lymph adenopathy preceded as one of symptoms of the disseminated tuberculosis in this case. It is said to be rare that abdominal lymph node swelling is seen in the early stage of disseminated tuberculosis. But, we think that it is necessary to keep in mind that the possibility of disseminated tuberculosis as one of the diseases in differential diagnosis, when we examine enlargement of abdominal lymph nodes with symptoms suggesting the presence of infection such as fever.
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Affiliation(s)
- Junichi Tsuyusaki
- Department of Respiratory Medicine, National Hospital Organization Chiba-East National Hospital, 673 Nitona-cho, Chuo-ku, Chiba-shi, Chiba 260-8712 Japan.
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Verma S, Bhakta H, Nowain A, Kanel G, Squires K. Occult hepatic opportunistic infection (OI) and highly active antiretroviral therapy (HAART) induced immune reconstitution: an important cause of jaundice in a patient with AIDS. AIDS Res Hum Retroviruses 2006; 22:1052-3. [PMID: 17067277 DOI: 10.1089/aid.2006.22.1052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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12
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Gody JC, Kassa-Kelembho E, Bobossi-Serengbe G, Beyam EN, Bercion R. À propos d'un cas d'otite tuberculeuse primitive compliquée de méningoencéphalite au complexe pédiatrique de Bangui (République centrafricaine). Med Mal Infect 2006; 36:177-9. [PMID: 16580801 DOI: 10.1016/j.medmal.2006.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2005] [Accepted: 01/23/2006] [Indexed: 11/26/2022]
Abstract
The authors report a case of fatal tuberculous meningoencephalitis following chronic bilateral otitis media in a child. Mycobacterium tuberculosis was identified in the CSF and in the otitis secretions. There were no pulmonary tuberculosis signs, thus the tuberculous otitis was considered as primary. In high tuberculosis endemic areas like Central African Republic it is important to consider tuberculosis, in chronic otitis media resistant to non specific therapy, and to reinforce the immunization programs for children.
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Affiliation(s)
- J-C Gody
- Clinique médicale infantile du complexe pédiatrique, BP 607, Bangui, République centrafricaine.
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Hung MN, Sun HY, Hsueh PR, Hung CC, Chang SC. Meningitis due to Histoplasma capsulatum and Mycobacterium tuberculosis in a returned traveler with acquired immunodeficiency syndrome. J Formos Med Assoc 2005; 104:860-3. [PMID: 16496069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
Histoplasmosis has rarely been reported in Taiwan, and its clinical manifestations may be similar to those of tuberculosis. With increasing international travel, physicians need to be aware of the possibility of this disease when caring for patients with advanced human immunodeficiency virus (HIV) infection who have traveled to endemic areas. A 55-year-old Chinese male from Burma presented with concurrent histoplasmosis and tuberculous meningitis as the initial opportunistic infection of acquired immunodeficiency syndrome. Fever, altered mentation, pancytopenia, splenomegaly and marked elevations of serum lactate dehydrogenase (3601 U/L) and ferritin (>10(6) ng/mL) were noted. Despite treatment with amphotericin B and antituberculous therapy, the patient died on the 25th day of hospitalization. This case illustrates the complexity and challenges of management of opportunistic infections in travelers returning from Southeast Asia who are in the advanced stage of HIV infection.
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Affiliation(s)
- Min-Nan Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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14
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Cagatay AA, Caliskan Y, Aksoz S, Gulec L, Kucukoglu S, Cagatay Y, Berk H, Ozsut H, Eraksoy H, Calangu S. Extrapulmonary tuberculosis in immunocompetent adults. ACTA ACUST UNITED AC 2005; 36:799-806. [PMID: 15764164 DOI: 10.1080/00365540410025339] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Tuberculosis continues to be a significant cause of morbidity and mortality. Although tuberculosis usually attacks the lungs, other organs can also be affected, leading to extrapulmonary tuberculosis (EPT) or disseminated tuberculosis. This study retrospectively analysed the incidence, clinical sites and risk factors for EPT in 252 patients with EPT between 1 January 1991 and 30 June 2003. EPT was defined as clinical, laboratory, imaging, and/or histopathological evidence of mycobacterial infection in a site other than hilar lymph nodes or lung parenchyma. In our study group, tuberculous lymphadenitis (36.5%) was found to be the most common clinical presentation of EPT. 119 (47.2%) patients developed the severe form of EPT, according to the WHO report, and 133 (52.8%) patients developed the less severe form. A case history of pulmonary tuberculosis was found to be a risk factor for the development of EPT (p <0.05). The study showed that EPT is still a public health problem. These findings suggested that pulmonary tuberculosis may play a critical role in the development of EPT. 12-month therapy may be chosen in patients with EPT considering acceptable adverse effects without relapses.
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Affiliation(s)
- Arif Atahan Cagatay
- Departments of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Istanbul University, Turkey.
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Abstract
Tuberculous meningitis (TBM) develops most often when a caseating meningeal or sub-cortical focus, the Rich focus, discharges its contents into the subarachnoid space. It is recognized that TBM is frequently accompanied by miliary tuberculosis, but the relationship between the development of the Rich focus and miliary tuberculosis remains controversial. The original descriptions of Arnold Rich and Howard McCordock are reviewed together with the work of other pathologists and the observations of the natural history of tuberculosis by astute clinicians such as Arvid Wallgren and Edith Lincoln. Rich and McCordock dissociated miliary tuberculosis from a role in the pathogenesis of TBM, and this view continues to appear in reviews and textbooks dealing with TBM. We suggest, particularly in childhood, that miliary tuberculosis is indeed directly involved in the pathogenesis of TBM in as much as that the overwhelming bacillaemia that accompanies miliary tuberculosis serves to increase the likelihood that a meningeal or sub-cortical Rich focus will be established, which may in its turn caseate and give rise to TBM.
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Affiliation(s)
- P R Donald
- The Department of Paediatrics and Child Health, Tygerberg Children's Hospital and The Faculty of Health Sciences, The University of Stellenbosch, P.O. Box 19063, 7505 Tygerberg, South Africa.
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Sengöz G. [Evaluating 82 cases of tuberculous meningitis]. Tuberk Toraks 2005; 53:51-6. [PMID: 15765287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Tuberculous meningitis (TBM) is not the most common but the most serious clinical form of extrapulmonary tuberculosis. Serious complications resulting from difficulties in diagnosis and treatment of the disease makes it an important health problem. In our study, 82 patients with TBM, followed up in our clinic between January 1998-December 2002, are evaluated with their clinical and laboratory properties. 52% of our patients were females, 48% were males and their ages ranged from 15 to 70 with a mean of 32 years. The diagnosis was based on patients' history, clinical and laboratory properties, cerebrospinal fluid (CSF) findings and radiographic findings. 59% of our patients were grade II clinically, 29% were grade I, and 23% were grade III. Mostly observed complaints were headache (87%) and nausea-vomiting (63%) and fever (45%) and mostly seen physical findings were stiff neck (70%), alterations in consciousness (57%). Pleocytosis in CSF was detected in 94%, low CSF glucose level in 87%, and elevated CSF protein level in 82% of the patients. From CSF samples of 40 patients, out of total 82, Mycobacterium tuberculosis was isolated on Loewenstein-Jensen medium (49%). Nineteen patients had tuberculomas, 13 had basal meningitis, and 11 had hydrocephalus on cranial radiographic studies. 28% had miliary pattern and 26% had active infiltration and cavities on chest roentgenogram. A four-drug antituberculous regimen was administered for 88% of the patients and dexamethasone treatment was administered for 75%; 56 (68.3%) patients recovered from the illness, 14 (17%) patients had slight and 4 (4.9%) patients had serious neurological sequeales and 8 (9.8%) patients died in spite of tuberculous therapy. As a conclusion, TBM is an infectious disease with high morbidity and mortality rates. Various prognosis patterns may be observed according to the clinical grade of the patient on application. When suspected, an early diagnosis and early treatment of the disease are the most important factors which effect complication and mortality rates.
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Affiliation(s)
- Gönül Sengöz
- Haseki Education and Research Hospital Clinics of Infection Diseases and Clinical Microbiology, Istanbul, Turkey.
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Karalian MA, Stepanian SM, Ulumian AK, Karapetian ET. [The role of herpes simplex of type 1 infection in the development of tuberculous meningoencephalitis]. Probl Tuberk Bolezn Legk 2005:39-41. [PMID: 16496763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Cases of tuberculous meningoencephalitis in Armenia and a role of the activation of human herpes virus-1 (HHV-1) infection have been investigated. HHV-1 can be an independent factor in the development of meningoencephalitis and a cofactor that produces cellular immunodeficiency in patients with atypical tuberculous meningoencephalitis.
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Guseva EM, Diukanova MI, Gorovenko LI, Kamaĭdanova VB. [Causes of death from tuberculosis in children under the present-day conditions]. Probl Tuberk Bolezn Legk 2005:31-3. [PMID: 16279514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Analysis of the causes of death from tuberculosis in 15 children in one of the central regions of Russia has indicated that in the past 14 years, the territorial childhood mortality rates have been 0.10-0.20 per 100,000 children. The main cause of death is tuberculous meningoencephalitis (n = 10); caseous pneumonia (n = 3), and generalized tuberculosis with severe concomitant diseases (n = 2) were less common. Tuberculous meningoencephalitis was postmortally diagnosed in 4 children who had received intensive nonspecific therapy using large doses of corticosteroid hormones. This led to the development of severe pyonecrotic meningoencephalitis with great brain edema and hemorrhoidal portions, which was early known as steroid-induced tuberculosis.
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Affiliation(s)
- Peter R Donald
- Department of Pediatrics and Child Health, Faculty of Health Sciences, University of Stellenbosch, Tygerberg, South Africa
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AUERBACH O. Tuberculous meningitis: correlation of therapeutic results with the pathogenesis and pathologic changes. I. General considerations and pathogenesis. Am Rev Tuberc 2004; 64:408-18. [PMID: 14885671 DOI: 10.1164/art.1951.64.4.408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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DOERNER AA, NAEGELE CF, REGAN FD, CAMERON GF. The development of tuberculous meningitis following cortisone therapy. Am Rev Tuberc 2004; 64:564-71. [PMID: 14885688 DOI: 10.1164/art.1951.64.5.564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
Hydrocephalus is a common complication of tuberculous meningitis (TBM) in children. The aims of this study are to review our experience of hydrocephalus in childhood TBM and to evaluate the effect of the timing of ventriculoperitoneal shunting (VPS) on the final outcome. In this study, 156 patients with TBM and hydrocephalus were reviewed retrospectively between 1990 and 2000. Patients' ages ranged from 6 months to 15 years, with a mean age of 4.1 years. There were 85 boys, and the male-to-female ratio was 1.19:1.0. Sixty-two percent of the children were younger than 6 years old. VPS was performed 2 days after the diagnosis in 100 patients, and in the remaining 56 patients, 3 weeks after the diagnosis. The average follow-up period was 8.5 months. Good recovery or minor sequelae was seen in 82 patients (52.6%), and 51 died (12.3%). The timing of the VPS procedure and cerebral complications had an effect on the final outcome. Early VPS gave a better outcome in mild and moderate hydrocephalus (p = 0.040). This study has shown that early surgical procedure for mild/moderate hydrocephalus has a positive effect on the morbidity and mortality of hydrocephalus in childhood TBM (p = 0.014, p = 0.040, respectively). In severe hydrocephalus, there was a tendency for early shunting to have a positive effect on morbidity, although this did not reach statistical significance.
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Affiliation(s)
- Serdar Kemaloglu
- Department of Neurosurgery, School of Medicine, Dicle University, Diyarbakir, Turkey.
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23
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Alvarez L, Calvo E. Tuberculous meningitis following correction of kyphosis by spinal osteotomy. A case report. J Bone Joint Surg Am 2002; 84:1022-4. [PMID: 12063339 DOI: 10.2106/00004623-200206000-00019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Luis Alvarez
- Department of Orthopedics, Fundación Jiménez Díaz, Madrid, Spain.
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Abstract
The authors' data show a higher rate of pleural and meningeal involvement among extrapulmonary TB cases than expected by previous works. Special attention should be given to tuberculous meningitis cases among all extrapulmonary TB cases because of its high mortality rate. The most common extrapulmonary involvement is pleural. Pleural involvement is most common among the young male military service personnel. These data underscore the importance of determining pleural involvement among extrapulmonary TB cases and emphasize the need to consider clinic and epidemiologic differences in the diagnosis and evaluation of extrapulmonary TB. Finally, it seems unlikely that HIV infection currently has a role in the cause of extrapulmonary TB in the authors' region.
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MESH Headings
- Adolescent
- Adult
- Aged
- Cross-Sectional Studies
- Female
- HIV Infections/epidemiology
- Humans
- Male
- Middle Aged
- Prevalence
- Tuberculosis, Lymph Node/epidemiology
- Tuberculosis, Lymph Node/etiology
- Tuberculosis, Meningeal/epidemiology
- Tuberculosis, Meningeal/etiology
- Tuberculosis, Miliary/epidemiology
- Tuberculosis, Miliary/etiology
- Tuberculosis, Pleural/epidemiology
- Tuberculosis, Pleural/etiology
- Tuberculosis, Pulmonary/complications
- Tuberculosis, Pulmonary/epidemiology
- Turkey/epidemiology
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Affiliation(s)
- Bülent Ozbay
- Department of Pulmonary Diseases and Tuberculosis, Yüzüncü Yil University, Medical Faculty, Göğüs Hastahklari ve Tüberküloz, Anabilim Dali 65300, Van, Turkey.
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25
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Blaschke S, Steffgen J, Grunewald RW, Müller GA. Tuberculous meningitis in a renal transplant recipient. J Nephrol 2002; 15:93-5. [PMID: 11936435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Tuberculous meningitis is a very rare, but serious extrapulmonary complication of mycobacterial infections in immunocompromised patients, such as organ transplant recipients. We describe here a 66-year-old Turkish woman without any history of tuberculosis, who received a renal allograft transplant in 1994. After a pilgrimage to an endemic area for tuberculosis, she presented with fever and headache in August 1998. Clinical examination revealed positive meningism and hyperreflexia. Lymphocytosis was noted in her cerebrospinal fluid (CSF) and Mycobacterium tuberculosis infection was detected by PCR within the CSF. Despite immediate triple antituberculosis therapy, the patient's clinical condition deteriorated rapidly, with the development of septic shock syndrome, and she died three weeks after admission due to cardiovascular and respiratory failure. Mycobacterial infections, including extrapulmonary manifestations, should thus be considered in all renal transplant recipients presenting with unexplained fever. Preventive therapy, i.e. isoniazid prophylaxis, may also be recommended for patients risking exposure in areas endemic for tuberculosis.
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Affiliation(s)
- Sabine Blaschke
- Department of Nephrology and Rheumatology, Georg-August University, Göttingen, Germany.
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27
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Eyer-Silva WA, Pinto JFC, Arabe J, Morais-De-Sa CA. Paradoxical reaction to the treatment of tuberculosis uncovering previously silent meningeal disease. Rev Soc Bras Med Trop 2002; 35:59-61. [PMID: 11873263 DOI: 10.1590/s0037-86822002000100011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The development of paradoxical clinical worsening following initiation of tuberculosis treatment may complicate the clinical course of both HIV-infected and uninfected patients. We report a severe manifestation of the so called paradoxical reaction to the treatment of tuberculosis that unmasked previously silent meningeal disease in a 34-year-old HIV-infected male patient.
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Affiliation(s)
- Walter A Eyer-Silva
- Department of Clinical Immunology, Hospital Universitário Gaffrée e Guinle, Universidade do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
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Abstract
Urinary tuberculosis is frequent in Algeria. The discovery of the disease become difficult when one of the three criterium of the diagnostic does not allow a diagnosis of certitude. The authors reported the case of a 44 years-old patient admitted to hospital for tuberculous meningitis recovery from left nephrectomy for urinary lithiasis. The histology does not find specific lesions. Then, no antituberculous treatment is prescribed. The patient has developed renal and meningitis tuberculosis associated with urinary lithiasis. Koch's bacillus is found in the urine. The evolution under medical treatment was excellent. The urinary lithiasis has hided tuberculosis and the discovery of the disease was late.
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Affiliation(s)
- A Benabdellah
- Unité de réanimation, service des maladies infectieuses, CHU d'Oran, Oran, Algérie.
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29
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Pimentel ML, Alves SM, Novis SA, Brandão RZ, Belo Neto E. [Intracranial tuberculomas developing during treatment of pulmonary tuberculosis: case report]. Arq Neuropsiquiatr 2000; 58:572-7. [PMID: 10920425 DOI: 10.1590/s0004-282x2000000300028] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The classical presentation of neurotuberculosis is meningitis. Intracranial tuberculomas are a rare manifestation of neurotuberculosis and are due to hematogenous dissemination of distant focuses of Mycobacterium tuberculosis infection. Around 1% of patients with central nervous system tuberculosis develop intracranial tuberculomas some weeks or months after the beginning of the specific treatment with tuberculostatic chemotherapy. The involution of the lesions is slow and does not mean drug resistance nor lack of adequate treatment. We describe the case, diagnosed and treated at the 25th Infirmary of Santa Casa da Misericórdia do Rio de Janeiro, of an immunocompetent male patient who developed meningitis and multiple intracranial tuberculomas during the specific treatment of miliary tuberculosis. The literature is revised and the diagnosis, treatment and possible immunological mechanisms are discussed.
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MESH Headings
- Adult
- Antitubercular Agents/therapeutic use
- Humans
- Isoniazid/therapeutic use
- Magnetic Resonance Imaging/methods
- Male
- Pyrazinamide/therapeutic use
- Rifampin/therapeutic use
- Tomography, X-Ray Computed/methods
- Tuberculoma, Intracranial/diagnosis
- Tuberculoma, Intracranial/drug therapy
- Tuberculoma, Intracranial/etiology
- Tuberculosis, Meningeal/diagnosis
- Tuberculosis, Meningeal/drug therapy
- Tuberculosis, Meningeal/etiology
- Tuberculosis, Miliary/complications
- Tuberculosis, Miliary/drug therapy
- Tuberculosis, Pulmonary/complications
- Tuberculosis, Pulmonary/drug therapy
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Affiliation(s)
- M L Pimentel
- Faculdade de Medicina, Universidade Gama Filho, Brazil.
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Parra Ródenas JV, Riera Ayora M, Ronda Gasulla A, Herrera Ballester A. [Lumbosacral and meningeal polyradicular disease in a patient with HIV infection]. An Med Interna 1999; 16:435-6. [PMID: 10507175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
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31
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Feĭzullaeva NA. [Distribution of transplantation HLA antigens in children and adolescents with meningitis of various etiology]. Probl Tuberk 1999:43-4. [PMID: 10420751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
An interaction between HLA antigens and predisposition to meningitis of specific and nonspecific etiology was studied in children and adolescents from an Azerbaijan population. The distribution of HLA antigens was found to be heterogeneous in the patients with meningitis of various etiology. Tuberculous meningitis was characterized by a significant rise in the detection rate of HLA-DR3 antigen, by a considerable frequency of B14 and DR2 antigens; patients with purulent meningitis much more significantly showed HLA-B12 antigen; in terms of locus A, there was an increase in the detection rates of HLA-A19 antigen in serous meningitis.
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Tsushima K, Kubo K. [Tuberculous meningitis developed during treatment for systemic lupus erythematosus (SLE)]. Kekkaku 1999; 74:27-32. [PMID: 10067053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
A 51-year-old woman was admitted to our hospital complaining of fever and general fatigue. Physical examination revealed butterfly-like erythema in face, facial edema and diffuse purpura all over her body. Laboratory data showed renal dysfunction, nephrotic syndrome and active phase of SLE. She was administered first methylprednisolone (1g/day/3 days by intravenous drip) then prednisolone (60 mg/day/month, orally) and had immune adsorption therapy for eight times. However, 14 days after the last session of immune adsorption, she developed fever of 39 degrees C and mild headache, and then 3 days later, she gradually became unconscious. Brain CT showed hydrocephalus. We diagnosed her as having tuberculous meningitis based on the detection of acid-fast bacillus in cerebrospinal fluid, and began treatment with antituberculous agents. We suspected that tuberculous meningitis had caused hydrocephalus. We tried percutaneous drainage of the left ventricle for hydrocephalus. Brain MRI showed a tuberculoma depicted as a mass of low intensity in the right cerebellum on the T1-weighted image, and of high intensity on the T2-weighted image, and the meninx in the basal cistern was enhanced. After treatment with antituberculous agents, we performed serial brain MRI and examined cerebrospinal adenosine deaminase activity (ADA). Despite treatment with antituberculous agents, new intracerebral tuberculomas had developed in some areas, whereas they had disappeared in other areas. After treatment for 4 months, the level of cerebrospinal ADA became normal, and the patient recovered consciousness despite the presence of multiple tuberculomas. Both the cell counts and the level of ADA in cerebrospinal fluid are the good indicators of the activity of tuberculous meningitis and reflected its clinical course. Furthermore, the level of ADA in cerebrospinal fluid changed with brain MRI image. Serial brain MRI and examination of ADA in cerebrospinal fluid were useful to know the activity of tuberculous meningitis and to evaluate the response to treatment.
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Affiliation(s)
- K Tsushima
- Department of Internal Medicine, Nagano Red Cross Hospital, Japan
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Bossi P, Reverdy O, Caumes E, Mortier E, Meynard JL, Meyohas MC, Cabane J, Frottier J, Bricaire F. [Tuberculous meningitis: clinical, biological and x-ray computed tomographic comparison between patients with or without HIV infection]. Presse Med 1997; 26:844-7. [PMID: 9207881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES Determine possible differences in clinical manifestations, laboratory findings and neuroimaging results in tuberculous meningitis patients with and without HIV infection. PATIENTS AND METHODS We retrospectively reviewed data of 38 patients with positive cerebrospinal fluid cultures for Mycobacterium tuberculosis who were hospitalized in 3 university hospitals in Paris over the last 11 years. RESULTS There were 24 HIV-infected patients and 14 without HIV infection. Mean CD4 lymphocyte count was 103 +/- 180/mm3 in the HIV group. Age (median age = 33 years for the HIV group vs. 53 for the non-HIV group), sex ratio (3 vs. 0.75), and prior history of tuberculosis (46% vs. 43%) were similar in both groups. Clinical presentation was similar for headache (83% in HIV group vs. 50% in non-HIV group; p = 0.02) and confusion (54% vs. 93% in non-HIV group p = 0.05). Serum natremia (mmol/l) (131 +/- 5 vs. 125 +/- 8; p = 0.024), white blood cell count (x 10(9)/l) (5.8 +/- 4.7 vs. 10.7 +/- 1.7; p = 0.37) and erythrocyte sedementation rate (mm/h) (68 +/- 34 vs. 31 +/- 35; p = 0.003) were significantly different in the 2 groups. Median cerebrospinal fluid findings were similar in the 2 groups: leukocytes (x 10(6)/l) (375 +/- 860 vs 218 +/- 250), glucose (mmol/l) (2.3 +/- 0.9 vs 2.7 +/- 1.9) and protein (g/l) (3.8 +/- 7.1 vs. 2.6 +/- 1.6). CT-scans of the brain were similar in the 2 groups. Mortality during hospitalization was similar (42% vs 36%; NS). CONCLUSION HIV infection appears to have little impact on the presentation of tuberculous meningitis.
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Affiliation(s)
- P Bossi
- Service de Maladies infectieuses et tropicales Hôpital Pitié-Salpêtrière, Paris
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34
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Blank E. Learning from our errors. N Engl J Med 1997; 336:877; author reply 877-8. [PMID: 9072689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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35
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Kumar V, Patial RK, Mahindroo NK. Meningeal tuberculosis secondary to an unusual primary site. J Assoc Physicians India 1996; 44:749. [PMID: 9251360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- V Kumar
- Department of ENT; Indira Gandhi Medical College, Shimla
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36
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Martino R, Martínez C, Brunet S, Sureda A, López R, Domingo-Albós A. Tuberculosis in bone marrow transplant recipients: report of two cases and review of the literature. Bone Marrow Transplant 1996; 18:809-12. [PMID: 8899202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Over a 6 year period we have seen two cases of tuberculosis among 118 allogeneic and 237 autologous bone marrow (BMT) or peripheral blood transplants. Both patients had received an HLA-identical related allogeneic BMT. The first case suffered from extensive chronic graft-versus-host disease (GVHD) and developed pulmonary tuberculosis 19 months after BMT. An open-lung biopsy was required to establish the diagnosis, and response to antituberculosis agents was complete, with no relapse at 49 months post-BMT. The second patient received a CD4+ T lymphocyte-depleted BMT, was receiving steroids for acute GVHD and developed rapid-onset meningeal tuberculosis on day +107 post-BMT. Despite initial severe neurologic deterioration, response to antituberculosis agents was good, and she remains alive and well 11 months from BMT. Review of the scant literature on this topic reveals that this is a relatively rare infection in BMT recipients despite their often severely immunosuppressed condition, occurring mainly in recipients of T cell-depleted allogeneic grafts or those who develop GVHD.
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Affiliation(s)
- R Martino
- Unitat d'Hematologia Clinica, Hospital de Sant Pau, Barcelona, Spain
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37
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van Deutekom H, Smulders YM, Roozendaal KJ, van Soolingen D. Bacille Calmette-Guérin (BCG) meningitis in an AIDS patient 12 years after vaccination with BCG. Clin Infect Dis 1996; 22:870-1. [PMID: 8722959 DOI: 10.1093/clinids/22.5.870] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- H van Deutekom
- Tuberculosis Department, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
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Abstract
PURPOSE To elucidate a case of tuberculous choroiditis in a patient with the acquired immunodeficiency syndrome (AIDS). METHODS We treated a 35-year-old woman who had AIDS with neurologic involvement caused by Mycobacterium tuberculosis. She developed a yellow-white chorioretinal infiltrate with indistinct borders and mild vitreitis in the right eye, probably caused by this pathogen. RESULTS The patient's visual acuity improved in the right eye with healing of the ocular lesion and her neurologic condition improved after specific therapy with isoniazid, rifampin, and ethambutol. CONCLUSION Tuberculosis must be considered in the differential diagnosis of posterior uveitis and choroiditis in AIDS patients.
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Affiliation(s)
- C Muccioli
- Department of Ophthalmology, Federal University of São Paulo, Paulista School of Medicine, São Paulo Hospital, Brazil
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Dastur DK, Manghani DK, Udani PM. Pathology and pathogenetic mechanisms in neurotuberculosis. Radiol Clin North Am 1995; 33:733-52. [PMID: 7610242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The mechanisms and the changes described herein typically begin with a dense basal meningeal exudate often resulting from a "Rich focus" along the basal surface of the cerebrum or ventricular ependyma. In the interpeduncular fossa, when the exudate is copious, among other structures the proximal parts of the optic nerves and of the internal carotid arteries are seen surrounded and compressed by the exudate. This exudate is made up of small and large mononuclear cells, including epithelioid cells, which also act as macrophages and may fuse to form Langhans' giant cells. Further extension of this exudate along small proliferating blood vessels into the brain substance constitutes a border zone encephalitis with the development of focal and diffuse ischemic brain changes due to vasculitis. Entrapment and occasional arteritic occlusion of larger arteries, such as the middle cerebral in the Sylvian fissures, results in infarction. Blockage of the basal subarachnoid cisterns around the midbrain and pons by the dense basal exudate or narrowing of aqueduct and third ventricle by a small tuberculoma causes consequent hydrocephalus. Development of many or one large focal granuloma (i.e., tuberculoma) occurs in the cerebrum, cerebellum, and/or brain stem. Similar pathogenetic mechanisms produce tuberculous spinal meningitis myeloradiculopathy that may be secondary to or occur before cranial tuberculous meningitis. More extensive damage to the white matter may occur together with the infrequent onset of perivascular demyelination on the basis of a hypersensitivity reaction to tuberculoprotein (i.e., "allergic tuberculous encephalopathy"). Finally, there may be a part played by NO in the production of the vascular and perivascular inflammatory central nervous system changes and a role for the the potential beneficial action of corticosteroids, especially in cases of tuberculous encephalopathy.
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Affiliation(s)
- D K Dastur
- Medical Research Centre, Bombay Hospital, Bombay, India
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40
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Luca MC. [An update on the therapy of tuberculous meningitis]. Rev Med Chir Soc Med Nat Iasi 1995; 99:52-5. [PMID: 9524656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- M C Luca
- Clinica de Boli infecţioase, Universitatea de Medicină şi Farmacie Gr. T. Popa, Iaşi
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41
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Ghosh JB, Senapati S. Tuberculous meningitis in early infancy. Indian Pediatr 1994; 31:1568-9. [PMID: 7875827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Abstract
We used a test based on the polymerase chain reaction (PCR) for the detection of Mycobacterium tuberculosis DNA in 11 CSF samples from 10 HIV-seropositive patients in whom tuberculous meningitis was suspected. PCR was positive in nine samples from eight patients in whom clinical data, CSF findings, evidence of tuberculosis at an extraneural site, and response to antituberculous drug therapy supported the diagnosis, whereas cultures were positive in five of these nine samples and staining in only one. The PCR was negative in 14 CSF samples from the control group.
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Affiliation(s)
- L Folgueira
- Department of Microbiology, Hospital Doce de Octubre, Madrid, Spain
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43
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Berger JR. Tuberculous meningitis. Curr Opin Neurol 1994; 7:191-200. [PMID: 8081512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Tuberculous meningitis remains an illness with a substantial morbidity and mortality despite the introduction of effective antituberculous agents. The correct diagnosis is often initially unsuspected and, even when appropriately considered, may be difficult to unequivocally confirm. Since the advent of the AIDS era, the frequency of neurological disease due to mycobacterial infection has increased and the spectrum of the disease has changed. The effects of the AIDS epidemic, the role of computed tomography and magnetic resonance imaging, the value of newer laboratory techniques in establishing the diagnosis, and approaches to treatment are among the topics addressed in this review of tuberculous meningitis.
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Abstract
We found choroidal tubercles in two children with meningitis. This finding supposed an important clue in establishing a tuberculous etiology. Following, we discuss the evolution and fluorescein angiographic findings of choroidal tubercles. As many authors have remarked, a thorough fundus examination is of great value in cases of fever of undetermined origin and meningitis. Choroidal tubercles can also be the first sign of a common pulmonary or extrapulmonary tuberculosis.
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Affiliation(s)
- P Tejada
- Hospital 12 de Octubre, Madrid, Spain
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45
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Talwar R, Talukdar B, Gupta NC, Rath B. Ultrasonographic study in meningitis. Indian Pediatr 1993; 30:1225-8. [PMID: 8077016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- R Talwar
- Department of Pediatrics, Maulana Azad Medical College, New Delhi
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46
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Yang WT, Daly BD, Li EK, Hutchinson R. Cranial computed tomography in the assessment of neurological complications in critically ill patients with systemic lupus erythematosus. Anaesth Intensive Care 1993; 21:400-4. [PMID: 8214543 DOI: 10.1177/0310057x9302100404] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The cranial computed tomography findings in 22 critically ill patients with systemic lupus erythematosus in the intensive care unit were reviewed to document the spectrum of pathology encountered and to assess the contribution of cranial computed tomography to the diagnosis and management of such patients, many of whom had severe multisystem disease. Thirty-one scans were performed in 22 patients, all of which were abnormal. Premature cerebral atrophy was identified in fifteen patients (68%), cerebral infarction in five (23%), intracranial haemorrhage and cerebral oedema in four each (18%), and hydrocephalus in three (14%). Six patients had multiple pathologies. The cranial computed tomography findings confirmed the clinical diagnosis in 13 of 22 cases (59%) and altered it in nine (41%). The contribution to diagnosis and management justifies transportation and computed tomography scanning. The contribution to patient outcome, however, is uncertain as mortality was 91%.
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Affiliation(s)
- W T Yang
- Department of Radiology and Medicine, Prince of Wales Hospital, Hong Kong
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47
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Abstract
OBJECTIVE To characterize the symptoms, signs, laboratory findings, and outcome of culture-proven meningitis due to Mycobacterium tuberculosis in patients with and without human immunodeficiency virus (HIV) infection. DESIGN Retrospective chart review. SETTING Urban public general hospital in the United States. PATIENTS Fifteen patients with and 16 without HIV infection. MEASUREMENTS Demographics, symptoms, physical exam findings, serum sodium, complete blood cell count, CD4+ cell count, cerebrospinal fluid findings, imaging data, and in-hospital mortality. MAIN RESULTS Symptoms, signs, chest radiograph appearance, cerebrospinal fluid cell counts and chemistries, and mortality were similar in both groups (p = NS). Median CD4+ cell counts were lower in HIV-infected patients (median 99/mm3, range 7 to 251, versus 384/mm3, range 171 to 724 in those without HIV infection, p = 0.007). Intracerebral mass lesions were more common in the HIV-infected group (60% versus 14% in the uninfected group, p = 0.01), although the presence of a mass did not correlate with focal neurologic deficits, altered level of consciousness, or mortality. CONCLUSION With the exception of an increased incidence of intracerebral mass lesions in HIV-infected individuals, HIV infection appears to have little impact on the findings and in-hospital mortality of tuberculous meningitis.
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Affiliation(s)
- M P Dubé
- Department of Medicine, Los Angeles County-University of Southern California Medical Center 90033
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48
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Chiu NC, Pang F, Juh LT, Huang CJ. [Tuberculous otitis media, mastoiditis associated with meningitis: report of one case]. Zhonghua Yi Xue Za Zhi (Taipei) 1992; 49:131-4. [PMID: 1315195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Tuberculosis of the middle ear is rare; associated meningitis is even more unusual. This report contains our experience with a one and a half year old psychomotor retarded boy. He had a poor healing left postauricular abscess four months prior to admission. Also noted was postprandial vomiting and left sided involuntary movement. On admission spinal tapping was done. Results showed leukocytosis, with lymphocytes being predominant, as well as high protein and low glucose levels. A cranial CT revealed left mastoiditis, hydrocephalus, basal cistern abnormal enhancement and a prominent posterior fossa postcerebellar CSF space. Left radical mastoidectomy was performed. A biopsy showed caseous necrosis surrounded by epitheloid and Langhan's giant cells. He also received a ventriculoperitoneal shunt. The gastric and CSF were both positive for tuberculous culture.
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Affiliation(s)
- N C Chiu
- Department of Pediatric, Mackay Memorial Hospital
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49
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Hoheisel G, Chan KM, Dai LK, Chan KS, Sun AJ, Luk WK, Chan CH. [Involvement of the central nervous system in disseminated tuberculosis]. Dtsch Med Wochenschr 1991; 116:1228-33. [PMID: 1874123 DOI: 10.1055/s-2008-1063740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Four weeks after starting tuberculostatic treatment (with isoniazid, rifampicin, streptomycin and pyrazinamide) a 21-year-old man with pulmonary tuberculosis developed symptoms of a radiculomyelopathy as well as mild renal failure. After isoniazid and streptomycin had been discontinued and ethambutol and high doses of vitamin B6 had been added all signs and symptoms improved. However, 4 weeks later tuberculous meningitis occurred which at first seemed to respond to administration of 5 antituberculosis drugs and dexamethasone. But 3 weeks later the patient sustained a partial hemiparesis. Its cause was proven to be a tuberculoma in the region of the brainstem. During further administration of tuberculostatic drugs and glucocorticoids the symptoms gradually receded over 8 months. A 54-year-old man with pulmonary tuberculosis developed cranial nerve pareses and symptoms of cerebellar involvement (trunk ataxia, intention tremor, dysdiadochokinesia) 3 weeks after starting tuberculostatic treatment. Computed tomography revealed multiple intracerebral tuberculomas which gradually shrank with continuation of the tuberculostatic treatment plus glucocorticoids. These two case reports illustrate that in tuberculosis involvement of the CNS can express itself clinically through complex symptoms, sometimes even after the start of tuberculostatic treatment.
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Affiliation(s)
- G Hoheisel
- Medical Department, Haven of Hope Hospital, Hong Kong
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50
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Thora S, Singh SD, Chhaparwal BC. Tuberculosis meningitis--how early can it occur? Indian Pediatr 1991; 28:296-8. [PMID: 1937709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- S Thora
- MGM Medical College, MY Hospitals, Indore
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