Tuberculous meningitis: diagnosis and treatment overview.

Tuberculosis Research and Treatment
Grace E Marx, Edward D Chan

Abstract

Tuberculous meningitis (TBM) is the most common form of central nervous system tuberculosis (TB) and has very high morbidity and mortality. TBM is typically a subacute disease with symptoms that may persist for weeks before diagnosis. Characteristic cerebrospinal fluid (CSF) findings of TBM include a lymphocytic-predominant pleiocytosis, elevated protein, and low glucose. CSF acid-fast smear and culture have relatively low sensitivity but yield is increased with multiple, large volume samples. Nucleic acid amplification of the CSF by PCR is highly specific but suboptimal sensitivity precludes ruling out TBM with a negative test. Treatment for TBM should be initiated as soon as clinical suspicion is supported by initial CSF studies. Empiric treatment should include at least four first-line drugs, preferably isoniazid, rifampin, pyrazinamide, and streptomycin or ethambutol; the role of fluoroquinolones remains to be determined. Adjunctive treatment with corticosteroids has been shown to improve mortality with TBM. In HIV-positive individuals with TBM, important treatment considerations include drug interactions, development of immune reconstitution inflammatory syndrome, unclear benefit of adjunctive corticosteroids, and higher r...Continue Reading

References

Feb 1, 1979·American Journal of Epidemiology·L S FarerM P Meador
Jul 21, 1979·British Medical Journal·J A Dyer
Mar 5, 1992·The New England Journal of Medicine·J BerenguerE Bouza
Aug 1, 1992·Thorax·M Humphries
Jul 1, 1991·Calcified Tissue International·E C Moreno, T Aoba
Jan 1, 1991·Clinical Pharmacology and Therapeutics·S KaojarernS Krittiyanunt
Mar 1, 1991·The Pediatric Infectious Disease Journal·N I GirgisI A Mikhail
Jan 1, 1995·Antimicrobial Agents and Chemotherapy·J L GaillardC Coustere
Dec 1, 1993·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·S J KentA M Mijch
Dec 1, 1993·International Journal of Epidemiology·L C RodriguesJ G Wheeler
Jan 1, 1993·Scandinavian Journal of Infectious Diseases·P R DonaldP D van Helden
Feb 1, 1993·Tubercle and Lung Disease : the Official Journal of the International Union Against Tuberculosis and Lung Disease·A H Alzeer, J M FitzGerald
Jun 1, 1996·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·R VerdonM Wolff
Aug 1, 1997·Clinical Immunology and Immunopathology·C M MastroianniS Delia
Feb 6, 1998·The American Journal of Tropical Medicine and Hygiene·N I GirgisA J Mateczun
May 13, 1999·Proceedings of the National Academy of Sciences of the United States of America·L TsenovaG Kaplan
Aug 18, 1999·Archives of Disease in Childhood·R KumarN Kohli
Oct 8, 1999·Pharmacotherapy·J J KellyV A Long
Aug 16, 2000·The Journal of Infection·N J FarinhaV M Novelli
Sep 6, 2000·Tubercle and Lung Disease : the Official Journal of the International Union Against Tuberculosis and Lung Disease·E D ChanM D Iseman
May 10, 2001·Scandinavian Journal of Infectious Diseases·P E Fine
May 22, 2001·British Journal of Neurosurgery·D LamprechtH Hartzenberg
Oct 13, 2001·The New England Journal of Medicine·J KeaneM M Braun
Oct 10, 2002·Pediatric Neurosurgery·Serdar KemalogluMustafa Ozates
Nov 15, 2002·The New England Journal of Medicine·Jan de GansUNKNOWN European Dexamethasone in Adulthood Bacterial Meningitis Study Investigators
Feb 13, 2003·Scandinavian Journal of Infectious Diseases·Christine BidstrupAse Bengård Andersen
Nov 13, 2003·Gut·M StroudUNKNOWN British Society of Gastroenterology
Dec 13, 2003·Tuberculosis·Colin Ratledge
Mar 5, 2004·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·V B PatelT Mthiyane
May 14, 2004·European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology·I CorralS Moreno
Oct 22, 2004·The New England Journal of Medicine·Guy E ThwaitesJeremy J Farrar
Jun 9, 2005·The Journal of Infectious Diseases·Guy E ThwaitesJeremy J Farrar
Oct 18, 2005·Photosynthesis Research·C Mackenzie, S Kaplan
Mar 23, 2006·Infection and Immunity·Liana TsenovaGilla Kaplan

❮ Previous
Next ❯

Citations

May 10, 2013·Current Treatment Options in Neurology·Omar Siddiqi, Gretchen L Birbeck
May 7, 2013·International Journal of Antimicrobial Agents·Ethan Rubinstein, Yoav Keynan
May 20, 2015·Oxford Medical Case Reports·Talal HilalMalkanthie McCormick
Apr 9, 2013·The Journal of Infectious Diseases·Juraj Ivanyi, Alimuddin Zumla
Apr 17, 2015·Clinical Chemistry and Laboratory Medicine : CCLM·Chérina FlemingRobert de Jonge
Aug 21, 2013·Primary Care·Katherine PutzFred Arthur Zar
Sep 27, 2015·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·James A SeddonBeate Kampmann
Apr 25, 2016·Pharmacological Research : the Official Journal of the Italian Pharmacological Society·Patrícia Campi SantosDanielle G Souza
May 16, 2017·The Journal of Infection·Syed Beenish RufaiUNKNOWN TB Research Team
Sep 16, 2017·Archives of Disease in Childhood·Trevor DukeHenry Welch
Aug 11, 2017·BMJ Case Reports·Hanis ZuhaimySuresh K Vasudevan
Apr 7, 2018·BMJ Case Reports·Jose Danilo Bengzon DiestroPhilip Asuncion Ramiro
May 1, 2020·Clinical Microbiology Reviews·Roland NauHelmut Eiffert
Jul 30, 2020·Journal of Pharmaceutical Policy and Practice·Muhammad AtifZaheer-Ud-Din Babar
Oct 31, 2017·Case Reports in Infectious Diseases·Jason Selinger, Thar El Baage
Oct 24, 2019·Der Internist·Christoph LangeJan Heyckendorf
Sep 18, 2020·Journal of Clinical Medicine·Aysha ArshadVishwanath Venketaraman
Jan 8, 2017·Journal of the Pediatric Infectious Diseases Society·Kanokporn MongkolrattanothaiCharles Y Chiu
Nov 4, 2020·Antimicrobial Agents and Chemotherapy·Navarat PanjasawatwongJoel Tarning
May 29, 2018·Case Reports in Oncology·Hiroshi MatsumotoKohei Shitara

❮ Previous
Next ❯

Methods Mentioned

BETA
ELISA
nucleic acid amplification
PCR

Related Concepts

Related Feeds

Antitubercular Agents (ASM)

Antitubercular agents are pharmacologic agents for treatment of tuberculosis. Discover the latest research on antitubercular agents here.

CSF & Lymphatic System

This feed focuses on Cerebral Spinal Fluid (CSF) and the lymphatic system. Discover the latest papers using imaging techniques to track CSF outflow into the lymphatic system in animal models.

Antitubercular Agents

Antitubercular agents are pharmacologic agents for treatment of tuberculosis. Discover the latest research on antitubercular agents here.

Aminoglycosides

Aminoglycoside is a medicinal and bacteriologic category of traditional Gram-negative antibacterial medications that inhibit protein synthesis and contain as a portion of the molecule an amino-modified glycoside. Discover the latest research on aminoglycoside here.

Aminoglycosides (ASM)

Aminoglycoside is a medicinal and bacteriologic category of traditional Gram-negative antibacterial medications that inhibit protein synthesis and contain as a portion of the molecule an amino-modified glycoside. Discover the latest research on aminoglycoside here.