1/192. 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.- - - - - - - - - - ranking = 1keywords = meningitis (Clic here for more details about this article) |
2/192. 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.- - - - - - - - - - ranking = 5keywords = meningitis (Clic here for more details about this article) |
3/192. 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.- - - - - - - - - - ranking = 5keywords = meningitis (Clic here for more details about this article) |
4/192. 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.- - - - - - - - - - ranking = 5keywords = meningitis (Clic here for more details about this article) |
5/192. 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.- - - - - - - - - - ranking = 8keywords = meningitis (Clic here for more details about this article) |
6/192. Tuberculous meningitis in pregnancy--implications for mother and fetus: case report and literature review.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.- - - - - - - - - - ranking = 9keywords = meningitis (Clic here for more details about this article) |
7/192. 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.- - - - - - - - - - ranking = 8keywords = meningitis (Clic here for more details about this article) |
8/192. Spinal subdural tuberculous abscess.OBJECTIVES: Spinal subdural abscess is rare and only 48 cases have been described to date. In this report, we present an additional spinal subdural tuberculous abscess. METHOD: Tuberculous meningitis was diagnosed with clinical and laboratory findings in a 45-year-old man. A spinal subdural abscess was demonstrated using MRI. Presence of the abscess was revealed by surgical intervention. The diagnosis was confirmed by pathological examination. RESULTS: The patient had been treated for tuberculous meningitis 2 years previously. The disease recurred when anti-tuberculous therapy was prematurely discontinued. During the second treatment, the patient also underwent a ventriculo-peritoneal shunt operation for hydrocephalus. dizziness and weakness of both legs developed after the postoperative period. Spinal MRI showed a spinal subdural abscess as a iso-intense mass with spinal cord in the T1 and T2 weighted images, ring like enhancement and compression on the spinal cord at T3-T4 level. The patient underwent surgery and the abscess was drained. CONCLUSION: Tuberculosis may cause a spinal subdural abscess and although it is a rare disorder, when encountered MRI is very useful in the diagnosis.- - - - - - - - - - ranking = 2keywords = meningitis (Clic here for more details about this article) |
9/192. Issues arising from two related cases of childhood tuberculous meningitis.Two cases of childhood meningitis occurred in the same school within two weeks. The cases were cousins. The first case died and the aetiology was confirmed as tuberculous following a gene probe of a culture from the meningeal tissues at postmortem. The second case, with similar life threatening clinical features compatible with tuberculous meningitis, recovered. Seventy-seven contacts of the two cases among the immediate and extended families were screened. The adult sources of the infection were found to be two aunts of the second case, who were nurses working in the same nursing home. A further 73 contacts of the adult cases were identified. A total of eight close contacts to the aunts were given chemoprophylaxis and three were treated for tuberculosis. contact tracing was also undertaken in the nursing home but no further cases were identified. These two cases highlight the difficulties in making a rapid diagnosis in tuberculous meningitis, the difficulties in handling media and public concern with limited information, and deciding on the appropriate level of contact tracing in special circumstances.- - - - - - - - - - ranking = 7keywords = meningitis (Clic here for more details about this article) |
10/192. Paradoxical response to antitubercular drugs.Seven patients with paradoxical response to antitubercular drugs are reported. In three cases of intracranial tuberculomas, newer lesions appeared and in two cases preexisting tuberculomas enlarged. In two cases of tubercular meningitis, multiple tuberculomas appeared. All these cases exhibited newer symptoms and CT/MBI revealed the paradoxical response to antitubercular drugs. All responded to continued conservative therapy, with addition of pyrazinamide.- - - - - - - - - - ranking = 1keywords = meningitis (Clic here for more details about this article) |
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