scholarly journals Tuberculous Meningitis in The Differential Diagnosis of Cns Infection and the Urgency of Antituberculosis Treatment

2015 ◽  
Vol 1 (1) ◽  
Author(s):  
Sanliay Sahin ◽  
Mutlu U. Yazici ◽  
Ganime Ayar ◽  
Emine Akkuzu ◽  
Aslinur O. Parlakay ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Tuberculous Meningitis ◽  
Cns Infection ◽  
Antituberculosis Treatment

scholarly journals Stroke in a patient with tuberculous meningitis and HIV infection

2013 ◽  
Vol 5 (1) ◽  
pp. e2013017 ◽  
Author(s):  
Maria Bruna Pasticci ◽  
Maurizio Paciaroni ◽  
Piero Floridi ◽  
Enisia Cecchini ◽  
Franco Baldelli
Keyword(s):  
Risk Factors ◽  
Differential Diagnosis ◽  
Mycobacterium Tuberculosis ◽  
Side Effects ◽  
Hiv Infection ◽  
Tuberculous Meningitis ◽  
Clinical Manifestations ◽  
Treatment Needs ◽  
Caucasian Female ◽  
Meningeal Tuberculosis

Abstract. Tuberculous meningitis (TBM) is a devastating disease. TBM occurs more commonly in HIV infected patients. The influence of HIV co-infection on clinical manifestations and outcome of TBM is not well defined. Yet, some differences have been observed and stroke has been recorded to occur more frequently. This study reports on an HIV infected Caucasian female with lung, meningeal tuberculosis and stroke due to a cortical sub-cortical ischemic lesion.TBM was documented in the absence of neurologic symptoms. At the same time, miliary lung TB caused by multi-susceptible Mycobacterium tuberculosis was diagnosed. Anti-TB therapy consisting of a combination of four drugs was administered. The patient improved and was discharged five weeks later. In conclusion, TBM and multiple underling pathologies including HIV infection, as well as other risk factors can lead to a greater risk of stroke. Moreover, drug interactions and their side effects add levels of complexity. TBM must be included in the differential diagnosis of HIV infected patients with stroke and TBM treatment needs be started as soon as possible before the onset of vasculopathy.

Cerebrospinal Fluid: When Is It Worthwhile to Do a Lumbar Puncture?

CNS Spectrums ◽  
2008 ◽  
Vol 13 (S16) ◽  
pp. 25-27
Author(s):  
Elaine R. Peskind
Keyword(s):  
Cerebrospinal Fluid ◽  
Differential Diagnosis ◽  
Frontotemporal Dementia ◽  
Lumbar Puncture ◽  
Tau Proteins ◽  
Cns Infection ◽  
Rapid Decline ◽  
Practice Parameters ◽  
Diagnosis Of Dementia ◽  
Differential Diagnosis Of Dementia

Clinicians should have an understanding of a lumbar puncture is indicated in the differential diagnosis of dementia and delirium. In most cases, this procedure is not commonly performed in outpatient practice for the differential diagnosis of dementia. However, in patients who have acute or subacute onset or a very rapid decline—such as in suspected Creutzfeldt-Jakob disease (CJD)—cerebrospinal fluid (CSF) 14-3-3, and tau proteins can be diagnostic for at least sporadic CJD. Practice parameters from the American Academy of Neurology (AAN) suggest performing a spinal tap on patients ≤55 years of age. However, that recommendation may not always be beneficial, particularly in a patient who has a prominent family history of either Alzheimer’s disease (AD) or frontotemporal dementia. Per the AAN practice parameter, lumbar puncture for CSF analysis is indicated in the diagnosis of central nervous system (CNS) infection, carcinomatous meningitis, or CNS vasculitis.Beyond the clinically indicated lumbar puncture, there is utility of CSF biomarkers, including CSF Aβ42, total tau, and phospho-tau, which are the best studied. These biomarkers may be useful for cases involving atypical presentations of dementia, eg, when it is difficult to determine if the patient has AD versus frontotemporal dementia. They may be most useful for cases in which there is an atypical presentation of the fluorodeoxyglucose PET image or PET image features of both AD and frontotemporal dementia.

scholarly journals Randomized Pharmacokinetic and Pharmacodynamic Comparison of Fluoroquinolones for Tuberculous Meningitis

2011 ◽  
Vol 55 (7) ◽  
pp. 3244-3253 ◽  
Author(s):  
Guy E. Thwaites ◽  
Sujata M. Bhavnani ◽  
Tran Thi Hong Chau ◽  
Jeffrey P. Hammel ◽  
M. Estée Török ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Tuberculous Meningitis ◽  
Drug Exposure ◽  
Time Curve ◽  
Exposure Response ◽  
Antituberculosis Treatment ◽  
Improved Outcomes ◽  
Days Of Therapy ◽  
Fluid Penetration ◽  
New Treatments

ABSTRACTTuberculous meningitis (TBM) is the most lethal form of tuberculosis, and new treatments that improve outcomes are required. We randomly assigned adults with TBM to treatment with standard antituberculosis treatment alone or in combination with ciprofloxacin (750 mg/12 h), levofloxacin (500 mg/12 h), or gatifloxacin (400 mg/24 h) for the first 60 days of therapy. Fluoroquinolone concentrations were measured with plasma and cerebrospinal fluid (CSF) specimens taken at predetermined, randomly assigned times throughout treatment. We aimed to describe the pharmacokinetics of each fluoroquinolone during TBM treatment and evaluate the relationship between drug exposure and clinical response over 270 days of therapy (Controlled Trials number ISRCTN07062956). Sixty-one patients with TBM were randomly assigned to treatment with no fluoroquinolone (n= 15), ciprofloxacin (n= 16), levofloxacin (n= 15), or gatifloxacin (n= 15). Cerebrospinal fluid penetration, measured by the ratio of the plasma area under the concentration-time curve from 0 to 24 h (AUC0–24) to the cerebrospinal fluid AUC0–24, was greater for levofloxacin (median, 0.74; range, 0.58 to 1.03) than for gatifloxacin (median, 0.48; range, 0.47 to 0.50) or ciprofloxacin (median, 0.26; range, 0.11 to 0.77). Univariable and multivariable analyses of fluoroquinolone exposure against a range of different treatment responses revealed worse outcomes among patients with lower and higher plasma and CSF exposures than for patients with intermediate exposures (a U-shaped exposure-response). TBM patients most likely to benefit from fluoroquinolone therapy were identified, along with exposure-response relationships associated with improved outcomes. Fluoroquinolones add antituberculosis activity to the standard treatment regimen, but to improve outcomes of TBM, they must be started early, before the onset of coma.

The association between serum sodium levels and tuberculous meningitis compared to viral and bacterial meningitis: Multicenter retrospective cohort study

2021 ◽  
Author(s):  
Seunghee Na ◽  
Taewon Kim ◽  
In-Uk Song ◽  
Sung-Woo Chung ◽  
Seong-Hoon Kim ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Bacterial Meningitis ◽  
Tuberculous Meningitis ◽  
Serum Sodium ◽  
Retrospective Cohort ◽  
Total Population ◽  
Viral Meningitis ◽  
Lower Serum ◽  
Cross Sectional ◽  
Additional Information

Abstract We evaluated the association between hyponatremia and tuberculous meningitis (TBM) in hopes of providing additional information for the differential diagnosis of TBM from other types of infectious meningitis, especially from viral meningitis (VM). Cross-sectional and longitudinal data involving 5,026 participants more than 18 years of age were analyzed in the total population and the propensity-matched population. The initial and lowest sodium levels and longitudinal changes in TBM, VM, and bacterial meningitis (BM) patients were compared. The initial serum sodium levels were significantly lower in the TBM patients than in the VM and BM patients (136.9 ± 5.9 vs. 139.0 ± 3.1, p < 0.001 for TBM vs. VM, and 138.3 ± 4.7 mmol/L and p < 0.001 for TBM vs. BM) and it dropped significantly more steeply to lower levels in both the TBM and BM patients compared to the VM patients. Consequently, the lowest serum sodium levels were in the order of the TBM < BM < VM patients, which were also statistically significant in all subgroups. (131.8 ± 6.4, 133.1 ± 5.1, 137.4 ± 3.7, respectively, p < 0.001). The participants with lower serum sodium levels were more likely to have a diagnosis of TBM rather than VM, and this association was more pronounced for the lowest sodium levels than the initial sodium levels (OR 8.4 (95% CI: 4.5–15.8, p < 0.001)). The baseline and longitudinal evaluation of serum sodium levels can provide supportive information for the differential diagnosis of TBM from VM or BM.

scholarly journals Pharmacokinetics and Pharmacodynamics of Intensive Antituberculosis Treatment of Tuberculous Meningitis

2020 ◽  
Vol 107 (4) ◽  
pp. 1023-1033 ◽  
Author(s):  
Junjie Ding ◽  
Nguyen Thuy Thuong Thuong ◽  
Toi Van Pham ◽  
Dorothee Heemskerk ◽  
Thomas Pouplin ◽  
...  
Keyword(s):  
Tuberculous Meningitis ◽  
Pharmacokinetics And Pharmacodynamics ◽  
Antituberculosis Treatment

Differential diagnosis of scrub typhus meningitis from tuberculous meningitis using clinical and laboratory features

2017 ◽  
Vol 163 ◽  
pp. 76-80
Author(s):  
Ashraf V. Valappil ◽  
Sohanlal Thiruvoth ◽  
Jabir M. Peedikayil ◽  
Praveenkumar Raghunath ◽  
Manojan Thekkedath
Keyword(s):  
Differential Diagnosis ◽  
Tuberculous Meningitis ◽  
Scrub Typhus ◽  
Laboratory Features

scholarly journals Use of Roche AMPLICOR Mycobacterium tuberculosis PCR in Early Diagnosis of Tuberculous Meningitis

1998 ◽  
Vol 36 (5) ◽  
pp. 1251-1254 ◽  
Author(s):  
Alec Bonington ◽  
J. I. George Strang ◽  
Paul E. Klapper ◽  
Steven V. Hood ◽  
William Rubombora ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Mycobacterium Tuberculosis ◽  
Tuberculous Meningitis ◽  
Laboratory Findings ◽  
Antituberculosis Treatment ◽  
Few Data ◽  
A Prospective Study ◽  
Specific Diagnostic Test ◽  
Pcr Test ◽  
Csf Findings

Several nucleic acid-based amplification tests are available for the detection of Mycobacterium tuberculosis, but few data are available on their use in the diagnosis of tuberculous meningitis (TBM). We performed a prospective study to assess the Roche AMPLICORMycobacterium tuberculosis PCR test (TB AMPLICOR) for use in the diagnosis of TBM and compared it with direct Ziehl-Neelsen staining of smears, radiometric culture for M. tuberculosis, and clinical and cerebrospinal fluid (CSF) findings. Eighty-three CSF specimens collected from 69 patients with suspected meningitis in South Africa were tested by TB AMPLICOR. On the basis of clinical and laboratory findings, 40 of these patients were treated for TBM and 29 patients were not treated for TBM. Ten CSF samples from 10 patients were positive by TB AMPLICOR. Seven of these 10 patients were classified as having definite TBM, 2 were classified as having probable TBM, and 1 was classified as having possible TBM. The sensitivity of TB AMPLICOR for detecting cases of definite and probable TBM in patients from whom CSF specimens had been collected less than 10 days into antituberculosis treatment was 60.0%. Specimens from all 29 patients not treated for TBM were negative by the TB AMPLICOR, giving a 100% specificity. TB AMPLICOR is therefore more sensitive than the combination of Ziehl-Neelsen staining of smears and radiometric culture for M. tuberculosis and is a rapid and highly specific diagnostic test for TBM.

Relationship between tuberculous otomastoiditis and tuberculous meningitis

2007 ◽  
Vol 122 (9) ◽  
pp. 893-897 ◽  
Author(s):  
G Sonmez ◽  
V Turhan ◽  
M G Senol ◽  
E Ozturk ◽  
H O Sildiroglu ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Differential Diagnosis ◽  
Magnetic Resonance ◽  
Antibiotic Therapy ◽  
Causal Relationship ◽  
Tuberculous Meningitis ◽  
Clinical Condition ◽  
Resonance Imaging ◽  
Laboratory Findings ◽  
Meningeal Involvement

AbstractObjective:The aim of this study was to determine the correlation between tuberculous meningitis and tuberculous otomastoiditis.Materials and methods:Meningeal involvement sites were investigated by magnetic resonance imaging in 32 patients (21 males, 11 females) who had previously been diagnosed with tuberculous meningitis. Clinical and laboratory findings and responses to anti-tuberculous treatment were evaluated, and the presence of concomitant tuberculous otomastoiditis was also investigated.Results:The meningeal involvement site was unilateral (in the sylvian fissure and the perimesencephalic cistern) in 28 patients (87.5 per cent), and bilateral and widespread in four patients (12.5 per cent). Tuberculous otomastoiditis was found in 11 of the patients with tuberculous meningitis (34.3 per cent). Otomastoiditis was on the same side as the meningeal involvement in nine of these 11 patients. Bilateral otomastoiditis with meningeal involvement was observed in two patients.Conclusions:Tuberculous meningitis is frequently accompanied by otomastoiditis, although the exact causal relationship between the two conditions is unclear. Since meningitis is a serious clinical condition, concomitant otomastoiditis generally remains unrecognised. Tuberculosis should be considered in the differential diagnosis of patients with otitis or otomastoiditis who do not respond to antibiotic therapy.

scholarly journals A New Scoring System for the Differential Diagnosis between Tuberculous Meningitis and Viral Meningitis

2018 ◽  
Vol 33 (31) ◽  
Author(s):  
Sang-Ah Lee ◽  
Shin-Woo Kim ◽  
Hyun-Ha Chang ◽  
Hyejin Jung ◽  
Yoonjung Kim ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Tuberculous Meningitis ◽  
Scoring System ◽  
Viral Meningitis ◽  
New Scoring
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