Treatment outcome of neuro tuberculosis patients put on DOTS--an observation study from the field.

BACKGROUND: Effectiveness of intermittent Short Course Chemotherapy for Neuro Tuberculosis has not been well studied. There are only few reported studies on this issue in the world literature under filed conditions. Neurologists all over India are reluctant to accept Directly Observed Treatment Short course for neuro tuberculosis since its introduction in India. AIM: Assessing effectiveness of Revised National TB Control Programme (RNTCP-DOTS) regimens among neuro tuberculosis patients registered under the programme. METHODS: All the neuro tuberculosis patients referred to RNTCP for treatment were included in the study. Study population included only those patients diagnosed at higher centre and referred to RNTCP during the period Jan - Dec 2002, Alappuzha District. Diagnostic Algorithm as per RNTCP guidelines was strictly followed and treatment outcome and follow-up status were taken from tuberculosis register. No pediatric age group was included in the study. RESULTS: A total of 32 cases registered for DOTS regimen were included in the study, of whom 29 completed the treatment and all were asymptomatic at the end of treatment (85%). All patients received treatment as DOTS, but only 70% received actual DOTS. All patients were given nine months intermittent regimen as per RNTCP guidelines. Five patients died during the treatment (14%). This result shows that DOTS under field programme conditions are efficient in curing Neuro Tuberculosis. CONCLUSION: Good result was obtained with intermittent short course chemotherapy under programme conditions in neurotuberculosis.

Tuberculose do sistema nervoso central em crianças: 2. Tratamento e evoluçäo / Central nervous system tuberculosis in children: 2. Treatment and outcome

Sequelas neurológicas näo säo raras após o tratamento da tuberculose do sistema nervoso central (SNC), que é longo, trabalhoso e sujeito a complicações. Vários fatores säo implicados como determinantes de prognóstico. O objetivo deste estudo foi analisar o tratamento e a evoluçäo de 52 crianças com tuberculose do SNC de um hospital pediátrico terciário. A maioria dos pacientes (41 ou 78,8 por cento) utilizou corticosteróides associados ao esquema tríplice. A ocorrência de hidrocefalia foi comum (28 de 41 testados), porém apenas 8 (15,4 por cento) necessitaram de derivaçäo liquórica. Hiponatremia ocorreu em um terço dos casos testados. Hepatotoxicidade ao esquema tríplice aconteceu em 32 casos (61,5 por cento), porém apenas 3 (9,4 por cento) necessitaram de substituiçäo destas drogas. Ocorreram 8 (15,4 por cento) óbitos e 24 (46,1 por cento) casos desenvolveram sequelas ao fim do tratamento. Houve tendência de pior prognóstico entre os pacientes que näo usaram corticosteróides e os que apresentavam doença avançada ao diagnóstico

Progression of cns tuberculosis inspite of chemotherapy: a case report

A case of tuberculous meningitis with paradoxical progression to multiple brain tuberculoma and drug resistance during treatment has been described. Initially the patient presented as tuberculous meningitis with presence of AFB in CSF. CT scan of brain with controstenhancement revealed no abnormality on admission [5th October 1995]. Patient showed improvement clinically during chemotherapy but subsequently she developed total blindness due to bilateral primary optic atrophy. CT scan [6th November 1995] revealed hydrocephalus with left parietal lobe tuberculoma. V-P shunt was introduced [11th November 1995]. Follow-up CT scan was again done [7th March 1996], as the patient suddenly deteriorated, which detected bilateral multiple tuberculoma in brain. CSF study [21st March 1996] yielded AFB which was resistant to streptomycin and INH. New chemotherapy consisting of rifampicin, INH, pyrazinamide, PAS and ethionamide was continued for one year. Repeat CT scan [18th April 1996] detected regression of previous lesions. Last CSF study was normal. Patient's vision improved significantly though she had optic atrophy