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La tuberculosis (TB) sigue siendo un problema de salud pública mundial. La magnitud real de esta epidemia está subestimada debido a las dificultades en el diagnóstico en niños y al escaso reporte. El diagnóstico de TB infantil representa un desafío, ya que en el niño la infección suele cursar con manifestaciones clínicas inespecíficas y muchas veces es asintomática, lo que retrasa el diagnóstico, conllevando a este grupo etario a un alto riesgo de infección diseminada. A continuación, describimos el caso de un niño preescolar con tuberculosis meníngea (TM), con presentación clínica subaguda de fiebre, trastorno de sensorio progresivo y signos de hipertensión endocraneana. El antecedente epidemiológico permitió orientar el diagnóstico y el inicio de la terapia antituberculosa. La evolución clínica del paciente fue tórpida, desarrolló complicaciones muy graves, con desenlace fatal.
Tuberculosis (TB) remains a global public health problem. The true magnitude of this epidemic is underestimated due to difficulties in diagnosing children and poor reporting. The diagnosis of childhood TB represents a challenge, since in children the infection usually proceeds with nonspecific clinical manifestations and is often asymptomatic, which delays the diagnosis, leading this age group to a high risk of disseminated infection. We then describe the case of a preschool child with meningeal tuberculosis (TM), with subacute clinical presentation of fever, progressive sensory disorder and signs of intracranial hypertension. The epidemiological history allowed the diagnosis and initiation of anti-tuberculosis therapy to be guided. The clinical course of the patient was torpid, developed very serious complications, with a fatal outcome.
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Background: Tuberculous meningitis (TBM) is the main form of tuberculosis that affects the central nervous system and is associated with high rates of death and disability. The objective of this study was to study neurological symptoms in TBM patients using clinical diagnosis and MRI of spine and comparing with urodynamic study.Methods: Fifty one patients diagnosed with TBM were studied in Neurology Department of KGM Medical University, Lucknow. Uroflowmetry and urodynamic study were done to divide the patients into normal and abnormal. A detailed history taking, general physical and neurological examination using MRI spinal cord was done and recorded on a predesigned proforma.Results: Visual impairment, hemiparesis, paraparesis, abnormal tone and reflexes in lower limbs showed significant association with abnormality in urodynamic study. MRI spine showed significant relationship of spinal meningeal enhancement, lumbosacral arachnoiditis, with abnormal urodynamic study.Conclusions: We found a significant association between neurological symptoms and abnormal urodynamic
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The prevalence of tuberculosis, especially extrapulmonary tuberculosis is increasing worldwide. TB meningitis is one of severe manifestations of extra pulmonary TB. Prognosis of cases of multidrug resistance tuberculosis meningitis is worse and even more challenging in pregnant women. It’s mostly associated with increased frequency of maternal disability, hospitalisation during pregnancy, foetal growth retardation, prematurity, low-birth weight and increased perinatal mortality. As information on outcome of pregnancy among women with extra pulmonary TB is limited; various medical and surgical options for timely management has been discussed. Authors bring out a case report of a primigravida at 26 weeks gestation with severe multidrug resistant TB meningitis who was successfully managed at our hospital with a healthy infant.
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ObjectiveTo examine the clinical utility of four methods in diagnosis of tuberculous meningitis.Methods A total of 60 patients with tuberculous meningitis were included as study group and another 70 patients with non-tuberculous intracranial infection as control group. Four methods, including conventional acid fast stain,Myobacterium tuberculous culture in BACTEC MGIT 960, real-time lfuorescent quantitative polymerase chain reaction (FQ-PCR) and modiifed acid fast stain, were used to assay the cerebrospinal lfuid specimens for diagnosis of tuberculous meningitis.ResultsThe positive rate was 11.7% (7/60), 6.7% (4/60), 48.3% (29/60), and 61.7% (37/60), respectively in the study group as tested by the four methods. There was signiifcant difference between the four methods in the positive rate (P< 0.05). Modiifed acid fast stain was more sensitive than the other 3 methods in identifying tuberculous meningitis (P< 0.05). This method also could identify the intracellularM. tuberculosis. All the 8 samples from the 4 patients who were positive for culture ofM. tuberculosis were positive in the modiifed acid fast stain.Conclusions The modiifed acid fast staining method is simple, fast, signiifcantly more senstive in detection of the acid fastM. tuberculosis in CSF, either extracellular or intracellular. It is worthwhile to further investigate its usefulness in early diagnosis of tuberculosis meningitis.
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Un 15 a 25% de los casos de tuberculosis presentan infecciones extrapulmonares. El diagnóstico temprano y tratamiento adecuado ayuda a reducir el riesgo de complicaciones y secuelas. La implementación del tratamiento estrictamente vigilado ha mejorado el control global de la tuberculosis, sin embargo es menos efectivo en las áreas donde prevalece la infección por VIH, la tuberculosis multidrogoresistente, la pobreza y donde la baciloscopia es la herramienta diagnóstica, la cual es excluyente en niños. La falta de un método sensible retarda el diagnóstico en la infancia, se realizan esfuerzos para el desarrollo de métodos simpli cados pero aún se carece de ellos. Se reportan 2 casos de tuberculosis diseminada en pacientes pediátricos, indígenas, Vih negativos, en dos grupos etarios extremos. Un lactante de 11 meses con tuberculosis miliar, cavitaciones pulmonares, efusión pleural y neumonía bacteriana complicada agregada y un adolescente de 13 años con meningitis tuberculosa e infartos isquémicos, neumonía con efusión y engrosamiento pleural. Ambos casos de interés por la relevancia epidemiológica de esta patología en la región y la variabilidad en la presentación clínica lo que impone mantener un alto índice de sospecha clínica en presencia de cualquiera de los criterios diagnósticos de tuberculosis.
A 15-25% of cases of tuberculosis have extrapulmonary infections. The early diagnosis and appropriate treatment helps to reduce the risk of complications and sequelae. The implementation of the strictly secure treatment has improved the global tuberculosis control, however it is less e ective in areas where the infection by HIV, TB multidrugoresistant, poverty prevails and where the sputum smear is the diagnostic tool, which is exclusive in children. The lack of a sensible approach delays the diagnosis in childhood, e orts for the development of simpli ed methods, but still are lacking them. Reported 2 cases of disseminated tuberculosis in patients paediatric, indigenous peoples, HIV-negative, in two extreme age groups. An infant of 11 months with miliary tuberculosis, pulmonary cavitations, pleural e usion and added complicated bacterial pneumonia and a teenager of 13 years with tuberculous meningitis and ischemic stroke, pneumonia with e usion and pleural thickening. Both cases of interest in the epidemiological relevance of this pathology in the region and the variability in clinical presentation which imposes maintain a high index of clinical suspicion in the presence of any of the diagnostic criteria of tuberculosis.
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Objective To evaluate the clinical utility of interferon-gamma (IFN-γ) in serum and cerebrospinal fluid in the diagnosis of tuberculous meningitis .Methods IFN-γlevels in serum and cerebrospinal fluid were analyzed by ELISA method in 25 patients with tuberculous meningitis ,31 patients with viral meningitis and 12 patients with suppurative meningitis .Results The IFN-γlevels in cerebrospinal fluid were significantly higher in the patients with tuberculous meningitis (386 .3 ± 83 .5) ng/L than in the patients with viral meningitis (63 .4 ± 16 .2) ng/L or the patients with suppurative meningitis (116 .8 ± 22 .6) ng/L (P0 .05) .The sensitivity ,specificity and accuracy of IFN-γ level in cerebrospinal fluid for diagnosis of tuberculous meningitis were 92 .0% ,95 .3% and 94 .1% ,respectively .Conclusions Measurement of IFN-γlevel in cerebrospinal fluid may be helpful for the diagnosis of tuberculous meningitis .
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Tuberculosis (TB) is an infectious disease commonly found in both developing and developed countries. Tuberculosis meningitis (TBM) is a serious central nervous system infection with a high mortality rate despite anti-TB drug treatment and is associated with HIV/AIDS. The diagnosis of TBM is difficult since the clinical aspects of the disease are similar to other central nervous system infections, examination for AFB in cerebrospinal fluid (CSF) stained with Ziehl-Neelsen is not sensitive and culture of Mycobacterium tuberculosis from CSF takes too long to influence initial therapy. Delayed diagnosis and treatment of TBM results in high mortality and disability. We report a Lao patient who had pulmonary TB in combination with TBM (confirmed by positive AFB in a sputum examination and a positive culture of Mycobacterium tuberculosis in the CSF) whose diagnosis and treatment were delayed resulting in serious nervous system sequelae and disability which may not be easily reversible. We discuss TBM diagnosis and use of simple clinical and laboratory features and suggest a low threshold for empirical treatment with anti-TB drug in case of suspected TBM.
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Cerebrospinal fluid (CSF) and serum from patients with tuberculosis meningitis (TBM) and nontuberculosis meningitis were assayed for IgG antibody activity to purified protein derivative (PPD) by ELISA.The results showed that the patients with TBM clearly had higher levels of antibody to PPD antigen than did approrjate control groups (P0.05).Because of its sensitity, specificity,and rapidity value,this method can be used for early diagnosis of tuberculosis meningitis.