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Tuberculous Meningitis

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Meningitis caused by Mycobacterium fortuitum mimicking tuberculous meningitis in an immunocompetent patient: a case report and literature review.

Lingyun Shao, Siran Lin, Qingluan Yang, Ting Wang, Wen Jia, Shu Chen, Wenhong Zhang,

<title>Abstract</title> <p> Background: Nontuberculous mycobacteria (NTM) are a large group of microorganisms that mainly affect persons who have immune deficiency. Mycobacterium fortuitum is one of them, which usually cause soft tissue or pulmonary disease. Meningitis caused by M. fortuitum is extremely rare and is often confused with tuberculous ... Read more >>

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Hypertrophic pachymeningitis in a southern Chinese population: a retrospective study

Li Feng, Xuewen Xiao, Dongni Fu,

<title>Abstract</title> <p> <bold>Background </bold>Hypertrophic pachymeningitis (HP) is a fibrotic disorder featuring a thickening of the dura matter. Most HP studies were from Caucasian population and only a few studies of HP are available in China. In this study, we investigated the causes, clinical and imaging features and therapeutic ... Read more >>

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Longitudinal cerebrospinal fluid assessment in a patient with tuberculous meningitis-A case report.

Yuxin Chen, Xiaojin Liu, Xun Zhang, Zhihua Zhang, Xueqin Zhou, Yuqing Wang, Shucai Wu, Liheng Zheng,

BACKGROUND:Dynamic assessment of cerebrospinal fluid (CSF) is essential for diagnosis, treatment, and prognosis of tuberculous meningitis, one of the most severe forms of central nervous system (CNS) infection. CASE PRESENTATION:A 45-year-old man sought care as he developed confusion, clonic convulsion, and coma. Longitudinal, comprehensive analyses of cytological, biochemical, and microbial ... Read more >>

J. Clin. Lab. Anal. (Journal of Clinical Laboratory Analysis)
[2020, :e23286]

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Clinical, Imaging, and Laboratory Characteristics of Adult Mexican Patients with Tuberculous Meningitis: A Retrospective Cohort Study.

Miguel García-Grimshaw, Francisco Alejandro Gutiérrez-Manjarrez, Samuel Navarro-Álvarez, Alejandra González-Duarte,

Tuberculous Meningitis (TBM) is the most common form of central nervous system Tuberculosis (TB), accounting for 5-6% of extrapulmonary TB cases. Nowadays, TBM continues to be a major topic in public health because of its high prevalence worldwide. This retrospective study aimed to describe the clinical, laboratory, and imaging characteristics ... Read more >>

J Epidemiol Glob Health (Journal of epidemiology and global health)
[2020, 10(1):59-64]

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Successful Treatment of a Severe Vision-Threatening Paradoxical Tuberculous Reaction with Infliximab: First Pediatric Use.

Yara-Natalie Abo, Nigel Curtis, Coen Butters, Thomas H Rozen, Ben J Marais, Amanda Gwee,

A 7-year-old girl with tuberculous (TB) meningitis developed optochiasmatic arachnoiditis, a vision-threatening paradoxical reaction, after starting TB treatment including adjunctive steroid therapy. She was treated with infliximab with complete recovery. This is the first report of the use of a tissue necrosis factor α inhibitor for the treatment of a ... Read more >>

Pediatr. Infect. Dis. J. (The Pediatric infectious disease journal)
[2020, 39(4):e42-e45]

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First case report of tuberculous meningitis secondary to endometrial tuberculosis following a clandestine abortion.

Edinson Dante Meregildo Rodriguez, Miguel Villegas Chiroque, Juan Roberto Rodriguez Llanos, Halbert Christian Sánchez Carrillo, Stalin Vílchez Rivera, Marcela Cecilia Delgado Sánchez,

Tuberculous meningitis (TBM) is a medical emergency: it is the most severe, lethal and disabling clinical form of tuberculosis. We report the case of a 44-year-old woman who had undergone a clandestine abortion six weeks before admission. One week later, she had abnormal vaginal discharge. Three weeks prior to admission, ... Read more >>

Infez Med (Le infezioni in medicina)
[2020, 28(1):82-86]

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Platelet dysfunction and coagulation assessment in patients of tuberculous meningitis.

Rajesh Verma, Sagarika Mahapatro, Asutosh Kumar, Imran Rizvi, Ravindra Kumar Garg, Hardeep Singh Malhotra, Praveen Kumar Sharma, Ravi Uniyal,

INTRODUCTION:Tuberculous meningitis (TBM) is the most severe form of tuberculosis. As reported in various studies, stroke is common among patients with TBM, with a prevalence of 17-54%. The present study assessed platelet dysfunction and coagulation abnormality in patients with TBM. METHODS:This was a prospective observational study that included 123 consecutive ... Read more >>

Neurol. Sci. (Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology)
[2020, :]

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Management of intracranial tuberculous mass lesions: how long should we treat for?

Suzaan Marais, Ronald Van Toorn, Felicia Chow, Abi Manesh, Omar Siddiqi, Anthony Figaji, Johan Schoeman, Graeme Meintjes, ,

Tuberculous intracranial mass lesions are common in settings with high tuberculosis (TB) incidence and HIV prevalence. The diagnosis of such lesions, which include tuberculoma and tuberculous abscesses, is often presumptive and based on radiological features, supportive evidence of TB elsewhere and response to TB treatment. However, the treatment response is ... Read more >>

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Metagenomic Next-Generation Sequencing for Diagnosis of Infectious Encephalitis and Meningitis: A Large, Prospective Case Series of 213 Patients.

Xiao-Wei Xing, Jia-Tang Zhang, Yu-Bao Ma, Mian-Wang He, Guo-En Yao, Wei Wang, Xiao-Kun Qi, Xiao-Yan Chen, Lei Wu, Xiao-Lin Wang, Yong-Hua Huang, Juan Du, Hong-Fen Wang, Rong-Fei Wang, Fei Yang, Sheng-Yuan Yu,

Purpose: We assessed the performance of metagenomic next-generation sequencing (mNGS) in the diagnosis of infectious encephalitis and meningitis. Methods: This was a prospective multicenter study. Cerebrospinal fluid samples from patients with viral encephalitis and/or meningitis, tuberculous meningitis, bacterial meningitis, fungal meningitis, and non-central nervous system (CNS) infections were subjected to ... Read more >>

Front Cell Infect Microbiol (Frontiers in Cellular and Infection Microbiology)
[2020, 10:88]

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[Case of isolated neurosarcoidosis requiring differentiation from tuberculous meningitis].

Ichiro Deguchi, Takashi Osada, Tomonari Suzuki, Shinya Tabata, Eiichi Arai, Akira Uchino, Takeshi Hayashi, Shinichi Takahashi, Suketaka Momoshima, Masaki Takao,

A 62-year-old woman was transported to our hospital for management of generalized clonic seizures. Cerebrospinal fluid examination showed an increased monocyte-dominant cell count, high protein concentration, and low glucose concentration that was 17% of the plasma glucose concentration. Contrast-enhanced cranial magnetic resonance imaging revealed diffuse leptomeningeal enhancement with multiple nodular ... Read more >>

Rinsho Shinkeigaku (Rinsho shinkeigaku = Clinical neurology)
[2020, 60(3):213-218]

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An unusual presentation of gross cerebral vascular dilatation in a TB/HIV co-infected individual.

Matthew Laurence Fielies, Iain Scott Walker,

Aneurysmal dilatation secondary to HIV vasculitis is well described being more common in patients under 45 years of age with advanced stage HIV infection (CD4 < 200 cells/µl). Tuberculous meningitis is far more common than previously anticipated with centres in Cape Town publishing that more than half of all cases of adult meningitis ... Read more >>

Br J Neurosurg (British journal of neurosurgery)
[2020, :1-4]

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Pharmacokinetics and Pharmacodynamics of Intensive Antituberculosis Treatment of Tuberculous Meningitis.

Junjie Ding, Nguyen Thuy Thuong Thuong, Toi Van Pham, Dorothee Heemskerk, Thomas Pouplin, Chau Thi Hong Tran, Mai Thi Hoang Nguyen, Phu Hoan Nguyen, Loc Phu Phan, Chau Van Vinh Nguyen, Guy Thwaites, Joel Tarning,

The most effective antituberculosis drug treatment regimen for tuberculous meningitis is uncertain. We conducted a randomized controlled trial comparing standard treatment with a regimen intensified by rifampin 15 mg/kg and levofloxacin for the first 60 days. The intensified regimen did not improve survival or any other outcome. We therefore conducted a nested ... Read more >>

Clin. Pharmacol. Ther. (Clinical pharmacology and therapeutics)
[2020, 107(4):1023-1033]

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Elevated Matrix Metalloproteinase Concentrations Offer Novel Insight Into Their Role in Pediatric Tuberculous Meningitis.

Yifan Joshua Li, Katalin A Wilkinson, Robert J Wilkinson, Anthony A Figaji, Ursula K Rohlwink,

We collected lumbar and ventricular cerebrospinal fluid and serum from 40 children treated for tuberculous meningitis and measured the concentrations of gelatinases and their inhibitors. The concentrations of matrix metalloproteinase 9 (MMP-9), MMP-2, tissue inhibitor of metalloproteinase 1 (TIMP-1), and TIMP-2 were significantly elevated in the lumbar CSF samples, and ... Read more >>

J Pediatric Infect Dis Soc (Journal of the Pediatric Infectious Diseases Society)
[2020, 9(1):82-86]

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Xpert MTB/RIF Ultra versus Xpert MTB/RIF for the diagnosis of tuberculous meningitis: a prospective, randomised, diagnostic accuracy study.

Joseph Donovan, Do Dang Anh Thu, Nguyen Hoan Phu, Vu Thi Mong Dung, Tran Phu Quang, Ho Dang Trung Nghia, Pham Kieu Nguyet Oanh, Tran Bao Nhu, Nguyen Van Vinh Chau, Vu Thi Ngoc Ha, Vu Thi Ty Hang, Dong Huu Khanh Trinh, Ronald B Geskus, Le Van Tan, Nguyen Thuy Thuong Thuong, Guy E Thwaites,

BACKGROUND:Xpert MTB/RIF Ultra (Xpert Ultra) might have higher sensitivity than its predecessor, Xpert MTB/RIF (Xpert), but its role in tuberculous meningitis diagnosis is uncertain. We aimed to compare Xpert Ultra with Xpert for the diagnosis of tuberculous meningitis in HIV-uninfected and HIV-infected adults. METHODS:In this prospective, randomised, diagnostic accuracy study, ... Read more >>

Lancet Infect Dis (The Lancet. Infectious diseases)
[2020, 20(3):299-307]

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New-onset seizures in adults with tuberculous meningitis during long-term follow-up: Characteristics, functional outcomes and risk factors.

Xiaosong Song, Lan Wen, Maolin Li, Xinyuan Yu, Lijun Wang, Kunyi Li,

OBJECTIVE:This study aimed to determine the characteristics and risk factors of adult new-onset seizure patients with tuberculous meningitis (TBM) during long-term follow-up. METHODS:Patients with TBM who were seen between June 2012 and January 2018 were retrospectively reviewed and categorized into two groups based on the presence or absence of new-onset ... Read more >>

Int. J. Infect. Dis. (International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases)
[2020, 93:258-263]

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Checklists to guide the supportive and critical care of tuberculous meningitis

Joseph Donovan, Ursula Rohlwink, Elizabeth Tucker, Nguyen Thi Thu Hiep, Guy Thwaites, Anthony Figaji, ,

The assessment and management of tuberculous meningitis (TBM) is often complex, yet no standardised approach exists, and evidence for the clinical care of patients, including those with critical illness, is limited. The roles of proformas and checklists are increasing in medicine; proformas provide a framework for a thorough approach to ... Read more >>

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Xpert MTB/RIF Ultra for the diagnosis of HIV-associated tuberculous meningitis: a prospective validation study.

Fiona V Cresswell, Lillian Tugume, Nathan C Bahr, Richard Kwizera, Ananta S Bangdiwala, Abdu K Musubire, Morris Rutakingirwa, Enock Kagimu, Edwin Nuwagira, Edward Mpoza, Joshua Rhein, Darlisha A Williams, Conrad Muzoora, Daniel Grint, Alison M Elliott, David B Meya, David R Boulware, ,

INTRODUCTION:Tuberculous meningitis accounts for 1-5% of tuberculosis cases. Diagnostic delay contributes to poor outcomes. We evaluated the performance of the new Xpert MTB/RIF Ultra (Xpert Ultra) for tuberculous meningitis diagnosis. METHODS:In this prospective validation study, we tested the cerebrospinal fluid (CSF) of adults presenting with suspected meningitis (ie, headache or ... Read more >>

Lancet Infect Dis (The Lancet. Infectious diseases)
[2020, 20(3):308-317]

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Ventriculoperitoneal shunt insertion in human immunodeficiency virus infected adults: a systematic review and meta-analysis

James Loan, Michael Poon, Steven Tominey, Ncedile Mankahla, Graeme Meintjes, Graham Fieggen,

<title>Abstract</title> <p> Background Hydrocephalus is a common, life threatening complication of human immunodeficiency virus (HIV)-related central nervous system opportunistic infection which can be treated by insertion of a ventriculoperitoneal shunt (VPS). In HIV-infected patients there is concern that VPS might be associated with unacceptably high mortality. To identify ... Read more >>

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Decision-making in the diagnosis of tuberculous meningitis

Tom Boyles, Lutgarde Lynen, James Seddon, ,

<ns5:p>Tuberculous meningitis (TBM) is the most devastating form of tuberculosis (TB) but diagnosis is difficult and delays in initiating therapy increase mortality. All currently available tests are imperfect; culture of <ns5:italic>Mycobacterium tuberculosis</ns5:italic> from the cerebrospinal fluid (CSF) is considered the most accurate test but is often negative, even when disease ... Read more >>

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Infections causing stroke or stroke-like syndromes.

Pasquale Pagliano, Anna M Spera, Tiziana Ascione, Silvano Esposito,

BACKGROUND:Stroke has relevant morbidity and mortality despite appropriate treatments and early diagnosis. Beside common risk factors such as diabetes and atrial fibrillation, infections can be involved in stroke pathogenesis, probably causing a systemic release of cytokines and other inflammatory mediators, triggering a latent pro-thrombotic state or damaging the vascular endothelium. ... Read more >>

Infection (Infection)
[2020, :]

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Establishing the cascade of care for patients with tuberculous meningitis

Darma Imran, Philip Hill, Jacob McKnight, Reinout van Crevel, ,

<ns5:p>Meningitis is a relatively rare form of tuberculosis, but it carries a high mortality rate, reaching 50% in some settings, with higher rates among patients with HIV co-infection and those with drug-resistant disease. Most studies of tuberculosis meningitis (TBM) tend to focus on better diagnosis, drug treatment and supportive care ... Read more >>

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BCG: a vaccine with multiple faces.

Marco Antonio Yamazaki-Nakashimada, Alberto Unzueta, Luisa Berenise Gámez-González, Napoleón González-Saldaña, Ricardo U Sorensen,

BCG has been recommended because of its efficacy against disseminated and meningeal tuberculosis. The BCG vaccine has other mechanisms of action besides tuberculosis protection, with immunomodulatory properties that are now being discovered. Reports have shown a significant protective effect against leprosy. Randomized controlled trials suggest that BCG vaccine has beneficial ... Read more >>

Hum Vaccin Immunother (Human vaccines & immunotherapeutics)
[2020, :1-10]

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Infections in patients diagnosed with multiple sclerosis: A multi-database study.

R Persson, S Lee, M Ulcickas Yood, Capt M Wagner Usn Mc, N Minton, S Niemcryk, A Lindholm, A M Evans, S S Jick,

BACKGROUND:Recent data on the rates of infections among patients with multiple sclerosis (MS) are sparse. The objective of this study was to quantify incidence of infections in patients with MS compared with a matched sample of patients without MS (non-MS). METHODS:This study was conducted in two separate electronic medical databases: ... Read more >>

Mult Scler Relat Disord (Multiple sclerosis and related disorders)
[2020, 41:101982]

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An improved protocol to establish experimental tuberculous meningitis in the rabbit.

Paul O'Brien, Christopher Vinnard, Selvakumar Subbian,

Tuberculous meningitis (TBM), caused by Mycobacterium tuberculosis (Mtb), is the deadliest form of tuberculosis in humans, particularly in children and the geriatric population. However, the host-pathogen interactions underlying TBM is not well understood. Rabbits are a valuable model system to study TB in humans. The rabbit model of TB recapitulates ... Read more >>

MethodsX (MethodsX)
[2020, 7:100832]

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Tuberculous meningitis: An unlikely cause of Guillain-Barre syndrome.

Dev Nishanth, Kumar Rahul, Kumawat Ashok, Chakravarthy Sanjay,

Guillain-Barre syndrome (GBS) is a life-threatening immune-mediated acute inflammatory polyneuropathy and is associated with various antecedent infections. Its association with tuberculosis is very uncommon with only a handful of cases being reported in the literature. It's association with tuberculous meningitis is even more scarce with only one case reported in ... Read more >>

Indian J Tuberc (The Indian journal of tuberculosis)
[2020, 67(1):139-142]

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