1/254. Vascular changes in tuberculous meningoencephalitis. Our report refers two cases of tuberculous encephalomeningitis which differ in the course and pathological changes. In case 1 blood vessels showed features of peri, endo-, or panvasculites. In some vessels endothelium proliferation leading to the stenosis or obliteration of the vascular lumen was observed. necrosis was an effect of vessels occlusion. In case 2 many fewer vessel were involved in onflammation process. Vascular changes were also less extensive and were observed more rarely. Tuberculous infection often caused less tissue lesions than vascular changes. Different pathological changes probably depend on the type and virulence of Myobacterium tuberculosis and on the host immune response to the infection. ( info) |
2/254. Tuberculosis meningitis in a patient with acute myelogenous leukemia. We present a case of tuberculous meningitis in a patient with acute myelogenous leukemia. The patient was in complete remission; he had persistent lymphopenia and CD4 T lymphocytopenia. diagnosis was complicated by the chronic and subacute nature of symptoms; some originally thought to be secondary to depression and chemotherapy related toxicity. Treatment was further complicated by the unusual phenomenon of paradoxical progression of disease while on appropriate therapy. This case illustrates the importance of consideration of mycobacteriosis in the differential diagnosis of chronic unexplained fever complicating treatment for acute leukemia. The natural history and essential aspects of diagnosis and treatment of CNS tuberculosis are reviewed. The clinical significance of unexplained CD4 T lymphocytopenia and chronic lymphopenia in patients with leukemia is also discussed. ( info) |
3/254. Disseminated tuberculosis: still a diagnostic challenge. Disseminated tuberculosis is notoriously difficult to diagnose and, with the decrease in tuberculosis incidence in australia, familiarity with its manifestations has dwindled. We describe four bacteriologically proven cases which illustrate the range of presentations and diagnostic difficulties. Surprisingly, immunosuppressive therapy need not cause rapid deterioration. Disseminated tuberculosis should be considered in any patient with multisystem illness who is at risk of tuberculosis, particularly if born overseas. In the absence of confirmatory results, a prompt therapeutic trial may be life-saving. ( info) |
4/254. meningitis or madness: a delicate balance. A child with meningitis who developed a psychosis 2 weeks after commencing treatment with antituberculous therapy is described here. The psychosis resolved with cessation of isoniazid, but the meningitis returned. The meningitis was treated by re-introduction of daily doses of isoniazid, but the psychosis recurred. Successful treatment of the meningitis, with minimal psychotic symptoms, eventually was achieved using isoniazid at 48 h dose intervals. The psychosis resolved completely after completion of therapy for tuberculous meningitis and cessation of isoniazid. This is the first case of isoniazid-associated psychosis reported in a child. ( info) |
5/254. Isolated leptomeningeal tuberculoma. Intracranial leptomeningeal tuberculoma without evidence of systemic tuberculosis is rarely encountered and is often difficult to diagnose because there are no specific signs or symptoms. A 49-year-old woman, without any past history of tuberculosis, presented with weakness and focal seizures in the right hand. Cranial magnetic resonance imaging revealed a leptomeningeal lesion in the left frontoparietal region. All conventional examinations demonstrated no evidence of tuberculous infection. The patient underwent biopsy, and histopathologic examination showed caseating granulomas compatible with tuberculomas. The culture of the surgical specimen grew mycobacterium tuberculosis 4 weeks later. The patient was then actively treated with antituberculous agents for 1 year. Subsequent clinical features and image studies showed the intracranial lesion in resolution. The findings of this case argue in favor of surgical biopsy when intracranial tuberculosis is clinically suspected, even without evidence of systemic tuberculous infection. ( info) |
6/254. diagnosis and treatment of complicated tubercular meningitis. A 41-year-old woman was seen in no acute distress with an infected ventriculoperitoneal shunt. She underwent several revisions of the shunt but was readmitted to the hospital with nausea, vomiting, and neurologic sequelae. Results of spinal fluid analysis were white blood cells 68/mm3 (25% neutrophils), glucose less than 20 mg/dl, and protein 513 mg/dl. cerebrospinal fluid, aerobic and anaerobic, and blood cultures were negative. Three weeks later the patient suffered a seizure and was prescribed antitubercular agents for a presumed diagnosis of tubercular meningitis. One week later, chest wound culture from her first visit suggested mycobacterium tuberculosis, which was confirmed by dna probe; cerebrospinal fluid culture eventually grew the organism. The patient fared well once she received antituberculosis agents. The time between first contact and treatment in the hospital delayed therapy. ( info) |
7/254. Multidrug-resistant tuberculosis meningitis: clinical problems and concentrations of second-line antituberculous medications. OBJECTIVE: [corrected] To describe a case of culture-proven multidrug-resistant tuberculous (MDR-TB) meningitis, in which the patient survived long enough for clinicians to adjust antituberculous therapy to second-line therapeutic agents. DESIGN: Case report. SETTING: Tertiary care hospital. PATIENT: Twenty-one-month-old girl with MDR-TB meningitis. INTERVENTIONS: Initial standard treatment failed. Subsequent treatment with second-line therapeutic agents including ciprofloxacin, cycloserine, ethambutol, ethionamide, and rifabutin were given for approximately two years. Concentrations of these drugs were measured in serum and cerebrospinal fluid in the presence and absence of meningeal inflammation. MAIN OUTCOME MEASURES/RESULTS: The patient survived for approximately two years after initiation of second-line anti-TB therapy. During this treatment, she developed a ventriculo-peritoneal shunt tunnel tract infection secondary to MDR-TB. CONCLUSIONS: All TB meningitis isolates for which the source case antibiotic susceptibility pattern is not known should be cultured and susceptibility tested using rapid broth techniques. Measurement and subsequent adjustment of therapeutic drug concentrations may optimize therapy with second-line anti-TB drugs in TB meningitis. Better pediatric formulations and pharmacokinetic data for second-line and anti-TB therapeutic agents are needed. ( info) |
| The objective of this article is to report an illustrative case of tuberculous meningitis in pregnancy and review the recent literature outlining management and outcome of this devastating disease. A medline database search for English and French language articles dating back to 1966 was conducted and supplemented by reviewing the references of key articles and textbooks. An article was included if it described a case of tuberculous meningitis during pregnancy or explained the management of this disease. The search yielded a total of 17 articles, case reports, and reviews relating to tuberculous meningitis and/or pregnancy. Six authors describe cases and outcomes of tuberculous meningitis during pregnancy to give a total of 55 cases. Twenty-one patients died of their disease (38.2%), while 15 fetal or neonatal deaths have been reported (36.6%). Tuberculous meningitis is an insidious disease presenting a diagnostic challenge to even an astute practitioner. When recognized early and treated effectively with modern antituberculous medication, prognosis for mother and child is greatly improved. ( info) |
| Tuberculous meningoencephalitis in a 24-month-old boy is reported. He contracted the infection from his apparently healthy grandfather with unnoticed pulmonary tuberculosis, as suggested by restriction fragment length polymorphism analysis of the isolated pathogen. ( info) |
10/254. Tuberculous meningitis in a Filipino maid. Tuberculous meningitis, while not uncommon in taiwan, has not been reported among foreign workers. We report the first case of tuberculous meningitis in a 37-year-old Filipino maid in taiwan, who presented with headache, fever and vomiting. She had been well before this episode and the small screening films of the chest radiograph obtained on her arrival in taiwan 15 months previously, and every 6 months thereafter showed no evidence of tuberculosis. The suspicion of tuberculous meningitis was delayed until disturbance of consciousness manifested and a standard chest radiograph showed a diffuse miliary pattern in both lung fields. A cerebrospinal fluid sample that was sent for a polymerase chain reaction-based assay specific for mycobacterium tuberculosis showed a positive result. The patient recovered with sequelae of mildly incoherent speech and urinary incontinence after antituberculous medication and short-course steroid treatment. Clinicians should be aware of the possibility of tuberculous meningitis in foreign workers with complaints of fever and headache. Because high-quality chest radiographs are a prerequisite for early detection of pulmonary tuberculosis, we recommended that standard posterior-anterior chest radiographs should be obtained as part of the routine health examination for foreign workers. ( info) |