1887

Chapter 18 : Central Nervous System Tuberculosis

MyBook is a cheap paperback edition of the original book and will be sold at uniform, low price.

Ebook: Choose a downloadable PDF or ePub file. Chapter is a downloadable PDF file. File must be downloaded within 48 hours of purchase

Buy this Chapter
Digital (?) $15.00

Preview this chapter:
Zoom in
Zoomout

Central Nervous System Tuberculosis, Page 1 of 2

| /docserver/preview/fulltext/10.1128/9781555817138/9781555815134_Chap18-1.gif /docserver/preview/fulltext/10.1128/9781555817138/9781555815134_Chap18-2.gif

Abstract:

Central nervous system (CNS) tuberculosis (TB) is among the least common yet most devastating forms of human mycobacterial infection. Conceptually, clinical CNS infection is seen to comprise three categories of illness: subacute or chronic meningitis, intracranial tuberculoma, and spinal tuberculous arachnoiditis. The sequence of events that leads to clinical neurologic illness begins with the hematogenous dissemination of that follows primary pulmonary infection or late reactivation TB elsewhere in the body. The continued proliferation and coalescence of tubercles result in larger caseous foci. Such lesions, if located adjacent to the ependyma or pia, may subsequently rupture into the subarachnoid space, producing meningitis. This conceptual understanding of the pathogenesis of tuberculous meningitis (TBM) is derived from the observations of Rich and McCordock, who performed meticulous autopsy examinations of TBM patients dying at the Johns Hopkins Hospital during the early part of the last century. The key to the diagnosis in most instances rests with the proper interpretation of the spinal fluid cellular characteristics and chemistries combined with the demonstration of mycobacteria in the cerebrospinal fluid (CSF) by stained smear or culture. The nucleic acid-based amplification technique, based on PCR, is a new and effective method for the rapid detection of specific bacterial DNA in clinical specimens. Late sequelae include cranial nerves (CN) palsies, gait disturbance, hemiplegia, blindness, deafness, learning disabilities, dementia, and various syndromes of hypothalamic and pituitary dysfunction.

Citation: Leonard J. 2011. Central Nervous System Tuberculosis, p 283-292. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch18

Key Concept Ranking

Brain Lesions
0.4741175
Magnetic Resonance Imaging
0.46891212
0.4741175
Highlighted Text: Show | Hide
Loading full text...

Full text loading...

Figures

Image of Figure 1.
Figure 1.

Computerized axial tomogram for a patient with TBM. Note the enlarged ventricles and effacement of sulci, indicating raised intracranial pressure.

Citation: Leonard J. 2011. Central Nervous System Tuberculosis, p 283-292. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch18
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of Figure 2.
Figure 2.

MRI of the same patient as for Fig. 1 . (A) After contrast enhancement, showing two dense, bilateral inflammatory masses (tuberculomas) in the region of the thalamus; (B) T-2 weighted image showing inflammatory edema and possible ischemic changes of vasculitis in the basal region of the temporal lobe (arrowhead).

Citation: Leonard J. 2011. Central Nervous System Tuberculosis, p 283-292. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch18
Permissions and Reprints Request Permissions
Download as Powerpoint

References

/content/book/10.1128/9781555817138.ch18
1. American Thoracic Society, Centers for Disease Control and Prevention, and Infectious Diseases Society of America. 2003. Treatment of tuberculosis. MMWR Recommend. Rep. 52:177.
2. Bagga, A.,, V. Kalra,, and O. P. Ghai. 1988. Intracranial tuberculoma: evaluation and treatment. Clin. Pediatr. 27:487490.
3. Behemuka, M.,, and J. H. Murungi. 1989. Tuberculosis of the nervous system: a clinical, radiological and pathological study of 39 consecutive cases in Riyadh, South Arabia. J. Neurol. Sci. 90:6776.
4. Berenguer, J.,, S. Moreno,, F. Laguna,, T. Vicente,, M. Adrados,, A. Ortega,, J. Gonzalez-LaHoz,, and E. Bouza. 1992. Tuberculous meningitis in patients infected with the human immunodeficiency virus. N. Engl. J. Med. 326:668672.
5. Bernaerts, A.,, F. M. Vanhoenacker,, P. M. Parizel,, J. W. Van Goethem,, R. Van Altena,, A. Laridon,, J. De Roeck,, V. Coeman,, and A. M. De Schepper. 2003. Tuberculosis of the central nervous system: overview of neuroradiological findings. Eur. Radiol. 13:18761890.
6. Berning, S. E.,, T. A. Cherry,, and M. D. Iseman. 2001. Novel treatment of meningitis caused by multidrug-resistant Mycobacterium tuberculosis with intrathecal levofloxacin and amikacin: case report. Clin. Infect. Dis. 32:643646.
7. Bhargava, S.,, A. K. Gupta,, and P. N. Tandon. 1982. Tuberculous meningitis—a CT study. Br. J. Radiol. 55:189196.
8. Bishburg, E.,, G. Sunderam,, L. B. Reichman,, and R. Kapila. 1986. Central nervous system tuberculosis with the acquired immunodeficiency syndrome and its related complex. Ann. Intern. Med. 105:210213.
9. Blazquez, E. P.,, M. Rodriguez,, and M. J. Mendez Ramos. 1994. Tuberculous choroiditis and acquired immune deficiency syndrome. Ann. Ophthalmol. 26:5054.
10. Bonington, A.,, J. I. Strang,, P. E. Klapper,, S. V. Hood,, W. Rubombora,, M. Penny,, R. Willers,, and E. G. Wilkins. 1998. Use of Roche AMPLICOR Mycobacterium tuberculosis PCR in early diagnosis of tuberculous meningitis. J. Clin. Microbiol. 36:12511254.
11. Braun, M. M.,, R. H. Byers,, W. L. Heyward,, C. A. Ciesielski,, A. B. Bloch,, R. L. Berkelman,, and D. E. Snider. 1990. Acquired immunodeficiency syndrome and extrapulmonary tuberculosis in the United States. Arch. Intern. Med. 150:19131916.
12. British Thoracic Association. 1981. A controlled trial of six months chemotherapy in pulmonary tuberculosis. Br. J. Dis. Chest 75:141153.
13. Centers for Disease Control and Prevention. 2005. Extrapulmonary tuberculosis cases and percentages by site of disease: reporting areas, 2005. Centers for Disease Control and prevention, Atlanta, GA. http://www.cdc.gov/tb/surv2005/PDF/tabl27.pdf.
14. Centers for Disease Control and Prevention. 2009. Trends in tuberculosis—United States, 2008. MMWR Morb. Mortal. Wkly. Rep. 58:249253.
15. Centers for Disease Control and Prevention. 2010. Data Statistics: Tuberculosis (TB) Is One of the World’s Deadliest Diseases. Centers for Disease Control and Prevention, Atlanta, GA. http://www.cdc.gov/tb/surv/statistics/default.htm.
16. Chan, K. H.,, R. T. Cheung,, R. Lee,, W. Mak,, and S. L. Ho. 2005. Cerebral infarcts complicating tuberculous meningitis. Cerebrovasc. Dis. 19:391395.
17. Chatterjee, V. K. K.,, D. R. Buchanan,, A. I. Friedmann,, and M. Green. 1986. Ocular toxicity following ethambutol in standard dosage. Br. J. Dis. Chest 80:288290.
18. Dastur, D. K. 1983. Neurosurgically relevant aspects of pathology and pathogenesis of intracranial and intraspinal tuberculosis. Neurosurg. Rev. 6:103110.
19. Dastur, D. K.,, D. K. Manghani,, and P. M. Udani. 1995. Pathology and pathogenetic mechanisms in neurotuberculosis. Radiol. Clin. N. Am. 33:733752.
20. Dube, M. P.,, P. D. Holtom,, and R. A. Larsen. 1992. Tuberculous meningitis in patients with and without human immunodeficiency virus infection. Am. J. Med. 93:520524.
21. Ellard, G. A.,, M. J. Humphries,, and B. W. Allen. 1993. Cerebrospinal fluid drug concentrations and the treatment of tuberculous meningitis. Am. Rev. Respir. Dis. 148:650655.
22. Farinha, N. J.,, K. A. Razali,, H. Holzel,, G. Morgan,, and V. M. Novelli. 2000. Tuberculosis of the central nervous system in children: a 20-year survey. J. Infect. 41:6168.
23. Girgis, N. I.,, Z. Farid,, M. E. Kilpatrick,, Y. Sultan,, and I. A. Mikhail. 1991. Dexamethasone adjunctive treatment for tuberculous meningitis. Pediatr. Infect. Dis. J. 10:179183.
24. Goldzieher, J. W.,, and J. R. Lisa. 1947. Gross cerebral hemorrhage and vascular lesions in acute tuberculous meningitis and meningo-encephalitis. Am. J. Pathol. 23:133145.
25. Harder, E.,, M. Z. Al-Kawi,, and P. Carney. 1983. Intracranial tuberculoma: conservative management. Am. J. Med. 74:570576.
26. Hinman, A. R. 1975. Tuberculous meningitis at Cleveland Metropolitan General Hospital, 1959–1963. Am. Rev. Respir. Dis. 95:670673.
27. Humphries, M. 1992. The management of tuberculous meningitis. Thorax 47:577581.
28. Kaneko, K.,, O. Onodera,, T. Miyatake,, and S. Tsuji. 1990. Rapid diagnosis of tuberculous meningitis by polymerase chain reaction (PCR). Neurology 40:16171618.
29. Karandanis, D.,, and J. A. Shulman. 1976. Recent survey of infectious meningitis in adults: review of laboratory findings in bacterial, tuberculous, and aseptic meningitis. South. Med. J. 69:449456.
30. Katrak, S. M.,, P. K. Shembalkar,, S. R. Bujwe,, and L. D. Bhandarkar. 2000. The clinical, radiological and pathological profile of tuberculous meningitis in patients with and without human immunodeficiency virus infection. J. Neurol. Sci. 181:118126.
31. Kennedy, D. H.,, and R. J. Fallon. 1979. Tuberculous meningitis. JAMA 241:264268.
32. Kent, S. J.,, S. M. Crowe,, A. Yung,, C. R. Lucas,, and A. M. Mijch. 1993. Tuberculous meningitis: a 30-year review. Clin. Infect. Dis. 17:987994.
33. Kingsley, D. P.,, W. A. Hendrickse,, B. E. Kendall,, M. Swash,, and V. Singh. 1987. Tuberculous meningitis: role of CT in management and prognosis. J. Neurol. Neurosurg. Psychiatry 50:3036.
34. Kocen, R. S.,, and M. Parsons. 1970. Neurological complications of tuberculosis: some unusual manifestations. Q. J. Med. 39:1730.
35. Kumar, R.,, N. Kohli,, H. Thavnani,, A. Kumar,, and B. Sharma. 1996. Value of CT scan in the diagnosis of meningitis. Indian Pediatr. 33:465468.
36. Lamprecht, D.,, J. F. Schoeman,, P. Donald,, and H. Hartzenberg. 2001. Ventriculoperitoneal shunting in childhood tuberculous meningitis. Br. J. Neurosurg. 15:119125.
37. Mitchison, D. A. 2000. Role of individual drugs in the chemotherapy of tuberculosis. Int. J. Tuberc. Lung Dis. 4:796806.
38. Noordhoek, G. T.,, A. H. Kolk,, G. Bjune,, D. Catty,, J. W. Dale,, P. E. Fine,, P. Godfrey-Faussett,, S. N. Cho,, T. Shinnick,, and S. B. Svenson. 1994. Sensitivity and specificity of PCR for detection of Mycobacterium tuberculosis: a blind comparison study among seven laboratories. J. Clin. Microbiol. 32:277284.
39. Offenbacher, H.,, F. Fazekas,, R. Schmidt,, R. Kleinert,, F. Payer,, G. Kleinert,, and H. Lechner. 1991. MRI in tuberculous meningoencephalitis: report of four cases and review of the neuroimaging literature. J. Neurol. 238:340344.
40. Ozateşs, M.,, S. Kemaloglu,, F. Gürkan,, U. S. Ozkan,, and M. M. Simşsek. 2000. CT of the brain in tuberculous meningitis. A review of 289 patients. Acta Radiol. 41:1317.
41. Pai, M.,, L. L. Flores,, N. Pai,, A. Hubbard,, L. W. Riley,, and J. M. Colford, Jr. 2003. Diagnostic accuracy of nucleic acid amplification tests for tuberculous meningitis: a systematic review and meta-analysis. Lancet Infect. Dis. 3:633643.
42. Poltera, A. A. 1977. Thrombogenic intracranial vasculitis in tuberculous meningitis. A 20 year “post mortem” survey. Acta Neurol. Belg. 77:1224.
43. Porkert, M. T.,, M. Sotir,, P. Parrott-Moore,, and H. M. Blumberg. 1997. Tuberculous meningitis at a large inner city medical center. Am. J. Med. Sci. 313:325331.
44. Rahman, N. U. 1980. Atypical forms of spinal tuberculosis. J. Bone Joint Surg. (Br.) 62:162165.
45. Rich, A. R.,, and H. A. McCordock. 1933. The pathogenesis of tuberculous meningitis. Bull. Johns Hopkins Hosp. 52:537.
46. Rieder, H. L.,, D. E. Snider, Jr.,, and G. M. Cauthen. 1990. Extrapulmonary tuberculosis in the United States. Am. Rev. Respir. Dis. 141:347351.
47. Schoeman, J.,, P. Donald,, L. van Zyl,, M. Keet,, and J. Wait. 1991. Tuberculous hydrocephalus: comparison of different treatments with regard to ICP, ventricular size and clinical outcome. Dev. Med. Child Neurol. 33:396405.
48. Schoeman, J.,, R. Hewlett,, and P. Donald. 1988. MR of childhood tuberculous meningitis. Neuroradiology 30:473477.
49. Schoeman, J. F.,, L. E. Van Zyl,, J. A. Laubscher,, and P. R. Donald. 1997. Effect of corticosteroids on intracranial pressure, computed tomographic findings, and clinical outcome in young children with tuberculous meningitis. Pediatrics 99:226231.
50. Sharma, S. K.,, A. Mohan,, A. Sharma,, and D. K. Mitra. 2005. Miliary tuberculosis: new insights into an old disease. Lancet Infect. Dis. 5:415430.
51. Slavin, R. E.,, T. J. Walsh,, and A. Pollak. 1980. Late generalized tuberculosis: a clinical pathologic analysis and comparison of 100 cases in the pre-antibiotic and antibiotic eras. Medicine 59:352366.
52. Smith, J.,, and R. Godwin-Austen. 1980. Hypersecretion of anti-diuretic hormone due to tuberculous meningitis. Postgrad. Med. J. 56:4144.
53. Tandon, P. N.,, and S. Bhargava. 1985. Effect of medical treatment on intracranial tuberculoma—a CT study. Tubercle 66:8597.
54. Teoh, R.,, M. J. Humphries,, and G. O’Mahony. 1987. Symptomatic intracranial tuberculoma developing during treatment of tuberculosis: a report of 10 patients and review of the literature. Q. J. Med. 63:449460.
55. Thwaites, G. E.,, T. T. Chau,, and J. J. Farrar. 2004. Improving the bacteriological diagnosis of tuberculous meningitis. J. Clin. Microbiol. 42:378379.
56. Thwaites, G. E.,, N. T. Lan,, N. H. Dung,, H. T. Quy,, D. T. Oanh,, N. T. Thoa,, N. Q. Hien,, N. T. Thuc,, N. N. Hai,, N. D. Bang,, N. N. Lan,, N. H. Duc,, V. N. Tuan,, C. H. Hiep,, T. T. Chau,, P. P. Mai,, N. T. Dung,, K. Stepniewska,, N. J. White,, T. T. Hien,, and J. J. Farrar. 2005. Effect of antituberculosis drug resistance on response to treatment and outcome in adults with tuberculous meningitis. J. Infect. Dis. 192:7988.
57. Thwaites, G. E.,, D. B. Nguyen,, H. D. Nguyen,, T. Q. Hoang,, T. T. Do,, T. C. Nguyen,, Q. H. Nguyen,, T. T. Nguyen,, N. H. Nguyen,, T. N. Nguyen,, N. L. Nguyen,, H. D. Nguyen,, N. T. Vu,, H. H. Cao,, T. H. Tran,, P. M. Pham,, T. D. Nguyen,, K. Stepniewska,, N. J. White,, T. H. Tran,, and J. J. Farrar. 2004. Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults. N. Engl. J. Med. 351:17411751.
58. Traub, M.,, A. C. Colchester,, D. P. Kingsley,, and M. Swash. 1984. Tuberculosis of the central nervous system. Q. J. Med. 53:81100.
59. Udani, P. M.,, and D. K. Dastur. 1970. Tuberculous encephalopathy with and without meningitis. Clinical features and pathological correlations. J. Neurol. Sci. 10:541561.
60. van Dyk, A. 1988. CT of intracranial tuberculoma with specific reference to the ‘target sign.’ Neuroradiology 30:329336.
61. Verdon, R.,, S. Chevret,, J. P. Laissy,, and M. Wolff. 1996. Tuberculous meningitis in adults: review of 48 cases. Clin. Infect. Dis. 22:982988.
62. Wadia, N. H.,, and D. K. Dastur. 1969. Spinal meningitides with radiculomyelopathy. Part I—clinical and radiological features. J. Neurol. Sci. 8:239260.
63. Weisberg, L. A. 1984. Granulomatous diseases of the CNS as demonstrated by computerized tomography. Comput. Radiol. 8:309317.
64. Whelan, M. A.,, and J. Stern. 1981. Intracranial tuberculoma. Radiology 138:7581.

Tables

Generic image for table
Table 1.

Presenting symptoms and signs of TBM

Citation: Leonard J. 2011. Central Nervous System Tuberculosis, p 283-292. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch18
Generic image for table
Table 2.

Differential diagnosis of TBM

Citation: Leonard J. 2011. Central Nervous System Tuberculosis, p 283-292. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch18

This is a required field
Please enter a valid email address
Please check the format of the address you have entered.
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error