RESUMEN
Tuberculous Meningitis (TBM) is the most common form of central nervous system Tuberculosis (TB), accounting for 5-6% of extrapulmonary TB cases. Nowadays, TBM continues to be a major topic in public health because of its high prevalence worldwide. This retrospective study aimed to describe the clinical, laboratory, and imaging characteristics at admission; and in-hospital outcome of adult Mexican patients with TBM. We collected data from medical records of patients aged ≥18 years diagnosed with TBM according to the uniform case definition for clinical research who were treated at Tijuana General Hospital between January 2015 and March 2018 and compared them according to the subtype of diagnosis. We included 41 cases (26 males, median age 28 years, range 18-57 years), 13 (31.7%) patients were HIV positive, and 21 (51.2%) were illicit drug users. At admission, 7 (17.1%) patients were in stage I, 22 (53.6%) in stage II, and 12 (29.3%) in stage III. A definitive diagnosis was established in 23 (56.1%) patients, probable in 14 (34.1%), and possible in four (9.8%). Molecular testing was positive in 83% of the cases, yielding significantly higher positive results than other microbiological studies. There were eight (19.5%) deaths, without statistical difference between mortality and not having a definitive diagnosis (p = 0.109). We found that the baseline characteristics of our population were similar to those described by other authors worldwide. In this series, molecular testing showed to be very useful when used in the early stages, particularly in subjects with subacute onset of headache, fever, weight loss, and altered mental status.
Asunto(s)
Tuberculosis Meníngea/diagnóstico , Tuberculosis Meníngea/tratamiento farmacológico , Tuberculosis Meníngea/epidemiología , Tuberculosis Meníngea/fisiopatología , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Humanos , Masculino , México/epidemiología , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Adulto JovenRESUMEN
Extrapulmonary tuberculosis (TB) represents approximately 15% of all TB infections. It is difficult to diagnose on the basis of imaging characteristics and clinical symptoms, and biopsy is required in many cases. Radiologists must be aware of the imaging findings of extrapulmonary TB to identify the condition in high-risk patients, even in the absence of active pulmonary infection. In extrapulmonary TB, the lymphatic system is most frequently affected. The presence of necrotic lymph nodes and other organ-specific imaging features increases the diagnostic probability of extrapulmonary TB. Disseminated infection and central nervous system involvement are the most frequent manifestations in immunosuppressed patients. Renal disease can occur in immunocompetent patients with very long latency periods between the primary pulmonary infection and genitourinary involvement. In several cases, gastrointestinal, solid-organ, and peritoneal TB show nonspecific imaging findings. Tuberculous spondylitis is the most frequent musculoskeletal manifestation. It is usually diagnosed late and affects multiple vertebral segments with extensive paraspinal abscess. Articular disease is the second most frequent musculoskeletal manifestation, and synovitis is its predominant imaging finding.©RSNA, 2019.
Asunto(s)
Imagen por Resonancia Magnética/métodos , Tuberculosis/diagnóstico por imagen , Absceso/diagnóstico por imagen , Absceso/fisiopatología , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Enfermedades Musculares/diagnóstico por imagen , Enfermedades Musculares/fisiopatología , Riesgo , Tuberculoma/diagnóstico por imagen , Tuberculosis/fisiopatología , Tuberculosis del Sistema Nervioso Central/diagnóstico por imagen , Tuberculosis del Sistema Nervioso Central/fisiopatología , Tuberculosis Ganglionar/diagnóstico por imagen , Tuberculosis Ganglionar/fisiopatología , Tuberculosis Meníngea/diagnóstico por imagen , Tuberculosis Meníngea/fisiopatología , Tuberculosis Osteoarticular/diagnóstico por imagen , Tuberculosis Osteoarticular/fisiopatología , Tuberculosis Urogenital/diagnóstico por imagen , Tuberculosis Urogenital/fisiopatologíaRESUMEN
Se presenta un caso de paciente masculino de 54 años de edad, sin inmunosupresión ni evidencia de la misma durante su hospitalización, que consulta por cefalea y signos meníngeos. Se realiza Punción Lumbar (PL) compatible con meningitis bacteriana por lo que se indica tratamiento empírico con mejoría franca de la sintomatología con excepción de la esorientación. Una vez en mejores condiciones se reciben los valores de la ADA los cuales están elevados compatibles con Tuberculosis Meníngea (TBM). Se realiza nueva PL para confirmar dicho valor, lo que se logra y además se demuestra un aumento leve. A los 20 días de la hospitalización, y luego de la mejoría franca, el paciente presenta nuevamente cefalea, fiebre y bradilalia por lo que se inicia tratamiento anti TB con mejoría progresiva de los síntomas. Se presenta el caso y se revisa la literatura(AU)
We present a 54-year-old male patient, with no immunosuppression who consulted for headache and meningeal signs. Lumbar tap (LT) was compatible with bacterial meningitis and empirical treatment was startes with a clear improvement in symptomatology, except for disorientation. Then ADA values were received and its values were francly compatible with Meningeal Tuberculosis (TBM). A new LT was performed to confirm this value, also showeds a slight increase. Twenty days after the hospitalization, and after the frank improvement, the patient again presented again with headache, fever and bradylalia, thus initiating anti-TB treatment with progressive improvement of symptoms. The case is presented and the literature is reviewed(AU)
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Tuberculosis Meníngea/fisiopatología , Meningitis Bacterianas/fisiopatología , Enfermedades del Sistema Nervioso , Diagnóstico Clínico , Medicina InternaRESUMEN
INTRODUCTION: To compare the effectiveness and safety of short term 6 month-treatment and long term 12 month-treatment schedules for meningoencephalitis due to tuberculosis in two hospitals from Lima-Peru. METHODS: Comparative, retrospective and observational study. The patients were divided in two groups: Group 1: long term 12 month-treatment with isoniazid, rifampin, pyrazinamide, and ethambutol for the first 2 months; then isoniazid and rifampin for 10 months. Group 2: short term 6 month-treatment with isoniazid and rifampin, pyrazinamide and ethambutol for the first 2 months; then isoniazid and rifampin for 4 months. Clinical records, effectiveness, treatment failure, treatment side effects, mortality and late consequences after treatment were reviewed. RESULTS: Twenty-six patients with meningoencephalitis level I were included, 10 received the long term schedule and 16 the short term schedule treatment. From 51 patients with meningoencephalitis level II, 27 received the long term schedule and 24 the short term schedule treatment and of 31 patients with meningoencephalitis level III, 18 received the long term schedule treatment and 13 the short term schedule treatment. There was no statistically significant differences among levels I, II and III when effectiveness of short and long term schedule was evaluated. Moreover, there was no statistically significant difference in the frequency of treatment failure, treatment side effects, mortality and late consequences among groups. CONCLUSIONS: Long term 12 month-treatment and short term 6 month-treatment had similar effectiveness and safety in the treatment of meningoenchephalitis due to tuberculosis in HIV negative patients.
Asunto(s)
Antituberculosos/uso terapéutico , Esquema de Medicación , Hospitales , Meningoencefalitis/tratamiento farmacológico , Meningoencefalitis/microbiología , Tuberculosis Meníngea/tratamiento farmacológico , Adolescente , Adulto , Anciano , Antituberculosos/administración & dosificación , Antituberculosos/efectos adversos , Quimioterapia Combinada , Etambutol/administración & dosificación , Etambutol/efectos adversos , Etambutol/uso terapéutico , Femenino , Humanos , Isoniazida/administración & dosificación , Isoniazida/efectos adversos , Isoniazida/uso terapéutico , Masculino , Meningoencefalitis/mortalidad , Meningoencefalitis/fisiopatología , Persona de Mediana Edad , Perú , Pirazinamida/administración & dosificación , Pirazinamida/efectos adversos , Pirazinamida/uso terapéutico , Estudios Retrospectivos , Rifampin/administración & dosificación , Rifampin/efectos adversos , Rifampin/uso terapéutico , Resultado del Tratamiento , Tuberculosis Meníngea/mortalidad , Tuberculosis Meníngea/fisiopatología , Adulto JovenRESUMEN
BACKGROUND: Tuberculous meningitis (TBM) is a growing problem in HIV-infected patients in developing countries, where there is scarce data about this co-infection. Our objectives were to analyze the main features and outcomes of HIV-infected patients with TBM. METHODS: This was a retrospective study of HIV-infected Brazilian patients admitted consecutively for TBM. All patients had Mycobacterium tuberculosis isolated from the cerebrospinal fluid (CSF). Presenting clinical and laboratory features were studied. Multivariate analysis was used to identify variables associated with death during hospitalization and at 9 months after diagnosis. Survival was estimated using the Kaplan-Meier method. RESULTS: We included 108 cases (median age 36 years, 72% male). Only 15% had fever, headache, and meningeal signs simultaneously. Forty-eight percent had extrameningeal tuberculosis. The median CD4+ cell count was 65 cells/microl. Among 90 cases, 7% had primary resistance to isoniazid and 9% presented multidrug-resistant strains. The overall mortality during hospitalization was 29% and at 9 months was 41%. Tachycardia and prior highly active antiretroviral therapy (HAART) were associated with 9-month mortality. The 9-month survival rate was 22% (95% confidence interval 12-43%). CONCLUSIONS: Clinical and laboratory manifestations were unspecific. Disseminated tuberculosis and severe immunosuppression were common. Mortality was high and the 9-month survival rate was low. Tachycardia and prior HAART were associated with death within 9 months of diagnosis.
Asunto(s)
Infecciones por VIH/complicaciones , Mycobacterium tuberculosis/aislamiento & purificación , Tuberculosis Meníngea/mortalidad , Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Infecciones Oportunistas Relacionadas con el SIDA/mortalidad , Infecciones Oportunistas Relacionadas con el SIDA/fisiopatología , Adolescente , Adulto , Brasil/epidemiología , Líquido Cefalorraquídeo/microbiología , Niño , Femenino , Infecciones por VIH/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Tasa de Supervivencia , Tuberculosis Meníngea/complicaciones , Tuberculosis Meníngea/microbiología , Tuberculosis Meníngea/fisiopatología , Adulto JovenRESUMEN
OBJECTIVE: To determine how many more patients would be treated when lowering the treatment threshold for tuberculous meningitis. METHODS: From 1989 to 2004 findings of patients with symptoms lasting more than 1 week and inflammatory changes of cerebrospinal fluid (CSF) were collected. Several models of latent class analysis were tested. Cumulative numbers of cases were plotted against different cut-offs for post-test probability. RESULTS: In a cohort of 232 patients the prevalence of tuberculous meningitis (TBM) was estimated at 79.8% (95% CI. 67,0-88,1); probabilities above 80% were reached in 73% of patients. Lowering this threshold from 80% to 20% would add 14% more patients to be treated, for a total of 87%. A further lowering of the threshold to 5% would imply 5% more patients to be treated, bringing the cumulative number to 92%. The difference of lowering the threshold from 80% to 5% was 19%. CONCLUSION: In this setting, at least 75% of patients showing suggestive symptoms for more than a week and CSF changes very probably had TBM. The number of patients that should be treated does not increase linearly when lowering the threshold.
Asunto(s)
Modelos Estadísticos , Mycobacterium tuberculosis/aislamiento & purificación , Tuberculosis Meníngea/diagnóstico , Tuberculosis Meníngea/tratamiento farmacológico , Ecuador , Humanos , Prevalencia , Probabilidad , Sensibilidad y Especificidad , Factores de Tiempo , Tuberculosis Meníngea/líquido cefalorraquídeo , Tuberculosis Meníngea/epidemiología , Tuberculosis Meníngea/fisiopatologíaRESUMEN
A prevalência de meningite tuberculosa (MTB) nos países em desenvolvimento mantém-se alta, e a doença continua a ter uma elevada taxa de morbimortalidade entre crianças. Neste trabalho, relatamos nossa experiência com casos de MTB, mostrando os achados clínicos, laboratoriais e radiológicos, assim como o tratamento e a seqüência após alta hospitalar. Foram revisados os registros de 29 pacientes com MTB ocorridos no período de 1o de janeiro de 1984 a dezembro de 2001. Houve predomínio do sexo masculino e da cor branca. A média de idade do início dos sintomas foi de 43 meses, variando de 2 meses a 12 anos. O esquema terapêutico mais freqüente foi rifampicina, isoniazida e pirazinamida. Seis pacientes evoluíram para óbito. Todos os pacientes realizaram exames culturais de líquido cefalorraquidiano para M tuberculosis, sendo positivos em 5 (17%). TB pulmonar foi detectada em 8 casos. O tempo médio de internação foi de 41 dias. Quinze de 21 pacientes pesquisados fizeram vacina BCG. Dezenove pacientes (66%) tinham história de contato íntimo com familiar com TB. Lesão cerebral motora foi a seqüela mais freqüente. Glicorraquia menor de 40 mg/dl foi relacionado como fator de risco para lesão cerebral motora, assim como idade menor de 4 anos de idade. Nossos achados mostram que a ocorrência de sinais meníngeos pode funcionar como um fator de proteção para a ocorrência de lesão cerebral motora assim como de proteinorraquia maior que 300 mg/dl (AU)
The prevalence of tuberculous meningitis (TBM) in the developing countries remains high, and this disease still has a elevated rate of morbimortality among children. In this study,we report our cases of TBM, describing clinical, laboratorial and radiological findings, as well the treatment and outpatient follow up. Medical charts from 29 patients interned with TBM from January 1984 to December 2001 were reviewed. There were predominance of male sex and white race. The mean age at the start of clinical manifestations was 43 months old, ranging from 2 months old to 12 years old. The more frequent tuberculostatic association was rifampin, isoniazid and pyrazinamide. Six patients died. Cerebrospinal fluid was collected from all patients, and the cultures for M tuberculosis were positive in five cases (17%). Pulmonary disease was detected in 8 cases. The mean time of hospitalization was 41 days. Fifteen from 21 patients has done BCG vaccine. Nineteen patients (66%) had contact with contaminated household. Motor cerebral lesion was the more frequent sequelae. Glucorrachia less than 40 mg/dl was related as a risk factor to motor cerebral lesion, as weel as age less than 4 years old. Our findings also point to the occurrence of meningeal signs and protein from cerebrospinal fluid above 300 mg/dl as protective factors for arising of motor cerebral lesion (AU)
Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Lactante , Preescolar , Niño , Tuberculosis Meníngea/fisiopatología , Tuberculosis Meníngea/diagnóstico , Tuberculosis Meníngea/epidemiología , Brasil/epidemiología , Estudios RetrospectivosRESUMEN
A meningoencefalite tuberculosa (MET) é a forma mais grave das tuberculoses extrapulmonares, sendo o diagnóstico precoce a questão crucial para o bom êxito terapêutico. Com base em um estudo retrospectivo de 48 casos de MET, no HULW/UFPB, os autores observaram que a demora do paciente em procurar o atendimento médico, assim como a falta de padronização na abordagem do paciente com MET, contribuíram para o retardo do diagnóstico e do início da terapêutica tuberculostática específica e que a ocorrência de óbitos de seqüelas esteve relacionada ao estágio evolutivo da doença, independente do esquema terapêutico utilizado
Asunto(s)
Humanos , Aceptación de la Atención de Salud/psicología , Diagnóstico por Imagen , Tuberculosis Meníngea/diagnóstico , Tuberculosis Meníngea/fisiopatología , Tuberculosis Meníngea/terapia , Antituberculosos , Isoniazida , Pirazinamida , Rifampin , Prueba de TuberculinaAsunto(s)
Masculino , Adulto , Sistema Nervioso Central , Sistema Nervioso Central/patología , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Tuberculoma Intracraneal/diagnóstico , Tuberculoma Intracraneal/tratamiento farmacológico , Tuberculosis Meníngea/diagnóstico , Tuberculosis Meníngea/etiología , Tuberculosis Meníngea/fisiopatología , Tuberculosis Meníngea/tratamiento farmacológico , Tuberculosis Resistente a Múltiples Medicamentos , Argentina , Mycobacterium tuberculosis/patogenicidadAsunto(s)
Masculino , Adulto , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Sistema Nervioso Central/patología , Sistema Nervioso Central/diagnóstico por imagen , Tuberculoma Intracraneal/diagnóstico , Tuberculoma Intracraneal/tratamiento farmacológico , Tuberculosis Resistente a Múltiples Medicamentos , Tuberculosis Meníngea/etiología , Tuberculosis Meníngea/fisiopatología , Tuberculosis Meníngea/tratamiento farmacológico , Tuberculosis Meníngea/diagnóstico , Mycobacterium tuberculosis/patogenicidad , ArgentinaRESUMEN
This study assessed 231 cases of tuberculous meningitis of which 62 (26.8%) had diagnostic confirmation against 169 (73.2%) with only clinical picture and laboratorial indication for this diagnosis. Fifty-five percent of the sample was male; ages ranged from one month to 68 years, 42% comprising children below four years. Clinical, demographic and liquoric characteristics were investigated and compared amongst those with likely and confirmed diagnosis. In conclusion, attention is drawn to the severity of this disease with high rates of lethality mainly within the age-range of 0-4 years, and to the possibility of misdiagnosis in the presentation of acute forms and predominance of neutrophils in the liquor.
Asunto(s)
Tuberculosis Meníngea/epidemiología , Adolescente , Adulto , Factores de Edad , Anciano , Niño , Preescolar , Humanos , Lactante , Masculino , Persona de Mediana Edad , Factores de Riesgo , Tuberculosis Meníngea/diagnóstico , Tuberculosis Meníngea/fisiopatologíaRESUMEN
This study assessed 231 cases of tuberculous meningitis of which 62 (26.8%) had diagnostic confirmation against 169 (73.2%) with only clinical picture and laboratorial indication for this diagnosis. Fifty-five percent of the sample was male; ages ranged from one month to 68 years, 42% comprising children below four years. Clinical, demographic and liquoric characteristics were investigated and compared amongst those with likely and confirmed diagnosis. In conclusion, attention is drawn to the severity of this disease with high rates of lethality mainly within the age-range of 0-4 years, and to the possibility of misdiagnosis in the presentation of acute forms and predominance of neutrophils in the liquor.
Neste estudo foram avaliados 231 pacientes com meningoencefalite tuberculosa, sendo que 62 casos tiveram diagnóstico comprovado e 169 apresentavam quadro clínico e laboratorial compatíveis com este diagnóstico. Foram 127 (55%) pacientes do sexo masculino, a idade variou de 1 mês a 68 anos, com 97 (42%) na faixa etária igual ou inferior a um ano. As características clínicas, demográficas e liquóricas foram estudadas e comparadas entre os casos confirmados e os de diagnóstico provável. Em conclusão reafirmamos a gravidade desta doença, com altas taxas de letalidade principalmente na faixa etária de zero a quatro anos e a possibilidade de erros diagnósticos nas apresentações com formas agudas e predominância de neutrófilos no líquor.
Asunto(s)
Adolescente , Adulto , Anciano , Niño , Preescolar , Humanos , Lactante , Masculino , Persona de Mediana Edad , Tuberculosis Meníngea/epidemiología , Factores de Edad , Factores de Riesgo , Tuberculosis Meníngea/diagnóstico , Tuberculosis Meníngea/fisiopatologíaRESUMEN
Cerebrospinal fluid ethionamide concentrations were determined in 18 children (median age 26.5 months) with tuberculous meningitis complicated by raised intracranial pressure. Lumbar spinal fluid specimens were obtained before and after weekly hour-long monitoring of intracranial pressure. Thirty-five paired and four single specimens were evaluated. A dosage schedule of 15 mg/kg was used on 26 occasions, and a spinal fluid ethionamide concentration of 2.5 micrograms/ml, the in vitro minimal inhibitory concentration for Mycobacterium tuberculosis, was exceeded on only seven occasions (27%). A dosage of 20 mg/kg was administered on 13 occasions, and in only two instances (15%) was a concentration of 2.5 micrograms/ml not achieved. Ethionamide in a single daily dosage of 20 mg/kg should be considered for the initial treatment of tuberculous meningitis when the presence of isoniazid-resistant M. tuberculosis cannot be excluded.