Date: 12 Oct 2013
Central Nervous System Tuberculosis: Challenges and Advances in Diagnosis and Treatment
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Mycobacterium tuberculosis is one of the most prevalent human infections. Although the largest share of the burden of disease is in Africa and Asia, tuberculosis has a global footprint due to travel and migration. Resource constraints in many low- and middle-income countries are hampering efforts to control new infections and to prevent drug resistance. Infection of the central nervous system by Mycobacterium tuberculosis includes meningitis, tuberculoma, and abscess and carries a high morbidity and mortality. High clinical suspicion, combined with cerebrospinal fluid analysis and brain imaging studies, can improve the diagnostic certainty. The recent scale-up of nucleic acid amplification technology may allow earlier diagnosis of tuberculous meningitis in many regions of the world. Treatment of tuberculous infection of the central nervous system is usually empirical and follows conventional regimens for pulmonary tuberculosis. The optimal treatment regimen is still being elucidated and has been the subject of recent clinical trials.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
World Health Organization: Global tuberculosis report 2012. Available at http://apps.who.int/iris/bitstream/10665/75938/1/9789241564502_eng.pdf. Accessed May 2013.
Thwaites G, Fisher M, Hemingway C, et al. British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children. J Infection. 2009;59:167–87.CrossRef
Cherian A, Thomas SV. Central nervous system tuberculosis. Afr Health Sci. 2011;11:116–27.PubMed
Prasad K, Singh M: Corticosteroids for managing tuberculous meningitis (Review). Cochrane Database of Systematic Reviews2008, Issue 1. Art. No.: CD002244. doi:10.1002/14651858.CD002244.pub3
Katraka SM, Shembalkara PK, Bijwe SR, et al. The clinical, radiological and pathological profile of tuberculous meningitis in patients with and without human immunodeficiency virus infection. J Neurol Sci. 2000;181:118–26.CrossRef
Cecchinia D, Ambrosioni J, Brezzo C, et al. Tuberculous meningitis in HIV-infected patients: drug susceptibility and clinical outcome. AIDS. 2007;21:373–4.CrossRef
•• Marais S, Thwaites G, Schoeman JF, et al.: Tuberculous meningitis: a uniform case definition for use in clinical research. Lancet Infect Dis 2010, 10:803–812. The authors present a consensus case definition for the diagnosis of possible, probable, and definite tuberculous meningitis using a diagnostic score based on clinical, CSF, and cerebral imaging criteria and evidence of TB elsewhere.PubMedCrossRef
Hristea A, Olaru ID, Baicus C, et al. Clinical prediction rule for differentiating tuberculous from viral meningitis. Int J Tuberc Lung Dis. 2012;16:793–8.PubMed
Malhotra HS, Garg RK, Singh MK, et al. Corticosteroids (dexamethasone versus intravenous methylprednisolone) in patients with tuberculous meningitis. Ann Trop Med & Parasitol. 2009;103:625–34.CrossRef
•• Steingart KR, Sohn H, Schiller I, et al.: Xpert® MTB/RIF assay for pulmonary tuberculosis and rifampicin resistance in adults (Review). Cochrane Database of Systematic Reviews 2013, Issue 1. Art. No.: CD009593. doi:10.1002/14651858.CD009593.pub2. This review included 18 studies to determine summary estimates of the diagnostic accuracy of Xpert for the diagnosis of pulmonary TB and the detection of rifampicin resistance in adults.
Tortoli E, Russo C, Piersimoni C, et al. Clinical validation of Xpert MTB/RIF for the diagnosis of extrapulmonary tuberculosis. Eur Resp J. 2012;40:442–7.CrossRef
Raut T, Garg RK, Jain A, et al. Hydrocephalus in tuberculous meningitis: Incidence, its predictive factors and impact on the prognosis. J Infection. 2013;66:330–7.CrossRef
Ramzan A, Nayil K, Asimi R, et al. Childhood tubercular meningitis: an institutional experience and analysis of predictors of outcome. Ped Neurol. 2013;48:30–5.CrossRef
DeLance AR, Safaee M, Oh MC et al.: Tuberculoma of the central nervous system. J Clin Neurosci, 2013, http://dx.doi.org/10.1016/
WHO: Treatment of tuberculosis: guidelines – 4th ed. Available at http://whqlibdoc.who.int/publications/2010/9789241547833_eng.pdf. Accessed July 2013.
• Marais S, Meintjes G, Pepper DJ et al.: Frequency, severity, and prediction of tuberculous meningitis immune reconstitution inflammatory syndrome. Clin Infect Dis 2013, 56:450–60. This prospective study compared clinical and laboratory findings between HIV-infected patients with TBM who developed immune reconstitution inflammatory syndrome and those who did not.PubMedCrossRef
Odendal L: Xpert MTB/RIF diagnostic test for TB: a global update. http://www.aidsmap.com/Xpert-MTBRIF-diagnostic-test-for-TB-a-global-update/page/2685513/. Accessed June 2013.
- Central Nervous System Tuberculosis: Challenges and Advances in Diagnosis and Treatment
Current Infectious Disease Reports
Volume 15, Issue 6 , pp 631-635
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