Clinical characteristics and prognosis of central nervous system tuberculosis in adults / 中华传染病杂志

Objective:To investigate the clinical characteristics of central nervous system tuberculosis in adults and the possible factors affecting the mortality and disability of the patients.Methods:The clinical data of patients diagnosed as "tuberculous meningitis" "tuberculous meningoencephalitis" "tuberculous cerebrospinal meningitis" or "tuberculous brain ubscess" in Huashan Hospital, Fudan University and Jing′an Branch, Huashan Hospital, Fudan University in Shanghai from January 1, 2010 to December 31, 2017 were collected, and a retrospective cohort was established. The clinical characteristics were analyzed, Medical Research Council (MRC) grade system was used to assess the severity of meningitis, and the modified Rankin Scale was used to assess the impairment of self-care. Survival rate and disability rate of the cohort were analyzed. Binary logistic regression was used for multivariate analysis. Kaplan-Meier survival curve was used for survival analysis.Results:A total of 161 patients with central nervous system tuberculosis were enrolled. Among the 161 patients, 55 cases (34.2%) were confirmed, 72 cases (44.7%) were highly suspected and 34 cases (21.1%) were suspected diagnosis. There were 56 cases (34.8%) with MRC grade Ⅰ, 76 cases (47.2%) with MRC grade Ⅱ and 29 cases (18.0%) patients with MRC grade Ⅲ before treatment. Up to January 1, 2019, ten (6.2%) patients died, 32 (19.9%) patients lost to follow-up, 119 (73.9%) patients survived. The five-year survival rate was 92.83%. There were 72 patients with no impact on life, 34 patients with moderate impact and 13 patients with severe impact. The disability rate was 39.5% (47/119). Binary logistic regression analysis showed that increasing age (odds ratio ( OR)=1.06, 95%confidence interval ( CI) 1.00 to 1.13, P=0.032) and deterioration of MRC grade during anti-tuberculosis treatment ( OR=89.00, 95% CI4.46 to 1 779.00, P=0.003) were independent risk factors for death. When severe disability and death were used as adverse outcomes, logistic regression analysis showed increasing age ( OR=1.07, 95% CI 1.01 to 1.13, P=0.035) and deterioration of MRC grade during anti-tuberculosis treatment ( OR=77.17, 95% CI4.45 to 1 337.00, P=0.003) were still independent risk factors for adverse outcomes. Conclusions:The mortality of central nervous system tuberculosis in adults in this cohort is relatively low, but the disability rate is still high. Increasing age and deterioration of MRC grade during anti-tuberculosis treatment are independent risk factors for death and disability.

A Case of Disseminated Multidrug-Resistant Tuberculosis involving the Brain / 감염과화학요법

We report a case of a 23-year-old female immigrant from China who was diagnosed with multidrug-resistant tuberculosis affecting her lung and brain, resistant to the standard first-line therapeutics and streptomycin. She was treated with prothionamide, moxifloxacin, cycloserine, and kanamycin. However, her headache and brain lesion worsened. After the brain biopsy, the patient was confirmed with intracranial tuberculoma. Linezolid was added to intensify the treatment regimen, and steroid was added for the possibility of paradoxical response. Kanamycin was discontinued 6 months after initiation of the treatment; she was treated for 18 months with susceptible drugs and completely recovered. To our knowledge, this case is the first multidrug-resistant tuberculosis that disseminated to the brain in Korea.

Abordagem diagnóstica da tuberculose pleural, ganglionar, renal e de sistema nervoso central / Diagnostic Approach to Tuberculosis in the Pleura, Lymph Nodes, Kidneys, and Central Nervous System

O objetivo do presente artigo foi relatar a abordagem diagnóstica da tuberculose pleural, ganglionar, renal e do sistema nervoso central. A forma mais frequente entre essas formas de tuberculose no Brasil é a tuberculose pleural, cujo diagnóstico na prática clínica baseia-se no exame histopatológico, com uma alternativa relatada nos últimos anos: a dosagem da enzima adenosina desaminase. A maioria dos achados laboratoriais encontrados implica na condição paucibacilar dessas formas extrapulmonares

The objective of this study was to report the diagnostic approach to tuberculosis of the pleura, lymph nodes, kidneys, and central nervous system. In Brazil, the most common extrapulmonary form of tuberculosis is that afecting the pleura. In clinical practice, pleural tuberculosis is typically diagnosed on the basis of the histopathological examination. However, in recent years, the determination of adenosine deaminase levels has been used as an alternative. Most laboratory indings indicate that these extrapulmonary forms are paucibacillary

Manifestações clínicas da tuberculose pleural, ganglionar geniturinária e do sistema nervoso central / Clinical Manifestations of Tuberculosis in the Pleura, Lymph Nodes,Urogenital System, and Central Nervous System

A tuberculose persiste como uma importante causa de morbidade e mortalidade mundial. Apesar de a forma pulmonar ser a apresentação mais importante e frequente, o acometimento extrapulmonar ocorre em aproximadamente 10-20% dos casos e em até 60% nos imunocomprometidos. Revisamos as principais manifestações clínicas dos mais importantes acometimentos extrapulmonares da tuberculose em nosso meio. O comprometimento pleural, ganglionar e urogenital são os mais comuns em nosso meio, além da importância do comprometimento do sistema nervoso central. A tuberculose costuma manifestar-se clinicamente como enfermidade subaguda a crônica, com sinais sistêmicos clássicos de febre baixa vespertina, emagrecimento e astenia, além daqueles que são dependentes do órgão afetado. Algumas dessas manifestações são revistas e descritas, lembrando, porém, que não existe quadro clínico patognomônico da enfermidade e que essa deve ser sempre lembrada no diagnóstico diferencial em nosso meio

Tuberculosis persists as a major cause of morbidity and mortality worldwide. Although the pulmonary form is more common and severe, the extrapulmonary form occurs in 10-20% of all cases and in up to 60% of cases in which the host is immunocompromised. This paper reviews the principal clinical manifestations of the most common types of extrapulmonary tuberculosis. Extrapulmonary tuberculosis most often afects the pleura, lymph nodes, urogenital system, and central nervous system, the last being the most common. In most cases, extrapulmonary tuberculosis is a clinically subacute or chronic disease, with symptoms speciic to the afected organ, as well as systemic signs, including a low fever, weight loss, and asthenia. Although some of these manifestations have been described, there is no pathognomonic clinical proile of the disease, which should always be included in the diferential diagnosis

Miliary Tuberculosis with Concurrent Brain and Spinal Cord Involvement: A Case Report

Central nervous system involvement by tuberculosis is rare, and intramedullary involvement is even more rare. A patient that developed intermittent amnesia during anti-tuberculous therapy underwent brain CT and MRI and spine MRI. The latter showed multiple small enhancing nodules in the brain and spinal cord. The patient was treated with anti-tuberculous medication and steroids under the suspected diagnosis of miliary tuberculosis. Follow-up CT showed decreased nodule size and number. We report a case of miliary tuberculosis in the brain and spinal cord and present a review of the literature related to similar cases.

MRI Findings of Miliary Tuberculosis of the Brain

PURPOSE: To evaluate MRI(Magnetic Resonance Imaging) findings of miliary tuberculosis of the brain. MATERIALS AND METHODS: Six patients with miliary tuberculosis of the brain diagnosed by characteristic clinical or laboratory findings were studied with spin echo MRI before and after contrast enhancement. We retrospectively evaluated MRI findings acording to the appearance, distribution, location, and enhancement pattern of the granulomas as well as associated other abnormalities. RESULTS: In six patients, contrast-enhanced MRI of thebrain showed numerous punctate, contrast enhancing lesions scattered throughout the brain. Unenhanced MRI failed to demonstrate small granulomas except a few small foci of high signal intensity on T2-weighted images. The shapes of enhancing granulomas were homogeneous nodular enhancement in 86% of cases and small ring enhancement in 14%.98% of granulomas were smaller than 3-mm and 2% were larger. Although several lesions were located in the basalganglia, thalamus, and brain stem, the majority were located in the subpial and subarachnoid space. There was no significant difference in distribution of granulomas between the supratentorial and the infratentorial areas. Other associated abnormalities were focal meningitis in five cases and focal cerebritis in one. On chest radiograph, all patients had miliary tuberculosis in the lungs. CONCLUSION: Contrast-enhanced T1-weighted MRimaging showed numerous round, very small enhancing lesions scattered throughout the brain. The majority of lesions were located in the subpial and subarachnoid space. Contrast-enhanced T1-weighted images are helpful inthe detection and diagnosis of miliary disseminated tuberculous granulomas and meningitis.

Intracranial Tuberculosis in Children: CT Findings before and after Treatment

OBJECT: To analyze the CT findings of intracranial tuberculosis in children at initial stage and during follow-up after treatment. MATERIALS AND METHODS: We evaluated 25 patients who were diagnosed by CSF analysis or response to anti-tuberculous medication as suffering from intracranial tuberculosis. There were 13 boys and 12 girls aged between 4 months and 14 years. Twenty-five initial and sixty-three follow-up CT scans were retrospectively analyzed. We evaluated the pattern of cisternal enhancement, the locations of infarction, and the presence of calcification and parenchymal granuloma. The changes of hydrocephalus and related complications, aswell as cisternal abnormality during anti-tuberculous medication were also evaluated. RESULTS: The initial findings on CT scan were hydrocephalus(75%), cisternal obliteration in precontrast study(64%), thick-line orring-shaped cisternal enhancement on postcontrast study(44%), infarctions(32%), calcifications(32%), periventricular edema(28%), and parenchymal granulomas(16%). On follow-up CT scan, hydrocephalus and cisternal enhancement had decreased to 35% and 82%, respectively, and the granulomas had changed to calcified nodules(100%). Ventriculo-peritoneal shunt or external ventricular drainage was needed in nine patients, and ventriculitis or complication of shunt procedure developed in four. CONCLUSION: Intracranial tuberculosis in children presented predominantly as meningitis involving basal cisterns and was associated with hydrocephalus. Infarction and calcification may be seen as parenchymal lesion. In spite of medical treatment, drainage was needed in about half the patients. During this treatment, the resolution of hydrocephalus, decreased cisternal enhancement, and calcification of the granulomas were seen.