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Central Nervous System Tuberculosis: Clinical Characteristics and Outcome. A Saudi Tertiary Care Centre Experience

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DOI: 10.4236/aid.2015.51007    3,181 Downloads   3,799 Views   Citations

ABSTRACT

Background: Tuberculosis is an endemic problem that is of important public health concern in Saudi Arabia. Available recent prevalence of tuberculosis (pulmonary and extra-pulmonary) was estimated to be 13.7 per 100,000 people living in the Kingdom of Saudi Arabia. Methods: A retrospective chart review of all Central Nervous System tuberculosis patients (CNS-TB) treated at King Abdulaziz Medical City, Riyadh, Saudi Arabia between 1996 and 2010. CNS-TB was defined as follows: patients who had symptoms and signs of CNS-TB with radiographic, microbiologic, or histopathologic evidence of tuberculous infection and/or those with highly probable diagnosis, supported by radiographic typical features, not confirmed microbiologically but who responded to anti-TB therapy. Results: Eighty two patients (46 males) met our definition with the mean age of 50 years. Only 11 patients (13.4%) reported previous TB infection. The most common presenting symptoms were: headache (51%), fever (50%), weakness (43%), confusion (29%) and seizures (28%). The most common signs found by clinical examination were: weakness (45%) followed by sensory impairment. Positive CSF acid-fast bacilli (AFB) culture confirmed the diagnosis in 20 out of 49 tested patients (about 41%). Brain CT scan was done in 74 patients and meningeal enhancement was identified in only 6 patients (8%) but ring enhancing lesions were found in 19 patients (26%). In MRI meningeal enhancement was founded in 26 patients (37%) and ring enhanced lesions in 36 patients (51%). After receiving treatment, 45 patients (55%) had complete or good recovery and 23 patients (28%) had partial recovery. However, 15% (12 patients) had poor or no improvement. 2 patients (2%) lost their follow up. Conclusion: CNS-TB continues to be a major health issue especially in endemic areas such as Saudi Arabia. The diverse clinical presentations, lack of high yield, practical and reliable diagnosis methods and inconsistent management plans require further research and harder work in order to meet the current challenges and reach a unified case definition and evidence based management guidelines that would be a very practical step.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Saeed, M. , Alothman, A. , Kojan, S. , Almahmoud, S. , Khathaami, A. and Ghobain, M. (2015) Central Nervous System Tuberculosis: Clinical Characteristics and Outcome. A Saudi Tertiary Care Centre Experience. Advances in Infectious Diseases, 5, 63-71. doi: 10.4236/aid.2015.51007.

References

[1] World Health Organization (2012) Global Tuberculosis Database.
www.who.int/tb/publications/global_report/en/index.html
[2] Phypers, M., Harris, T. and Power, C. (2006) CNS Tuberculosis: A Longitudinal Analysis of Epidemiological and Clinical Features. International Journal of Tuberculosis and Lung Disease, 10, 99-103.
[3] CDC (2012) Reported Tuberculosis in the United States, 2011. US Department of Health and Human Services, Atlanta.
[4] Hosoglu, S., Geyik, M.F., Balik, I., et al. (2002) Predictors of Outcome in Patients with Tuberculous Meningitis. International Journal of Tuberculosis and Lung Disease, 6, 64-70.
[5] Thwaites, G., Chau, T.T.H., Mai, N.T.H., et al. (2000) Tuberculous Meningitis. Journal of Neurology, Neurosurgery & Psychiatry, 68, 289-299.
http://dx.doi.org/10.1136/jnnp.68.3.289
[6] Thwaites, G.E. and Tran, T.H. (2005) Tuberculous Meningitis: Many Questions, Too Few Answers. Lancet Neurology, 4, 160-170.
http://dx.doi.org/10.1016/S1474-4422(05)70019-3
[7] Marais, S., Thwaites, G., Schoeman, J.F., Torok, M.E., Misra, U.K., et al. (2010) Tuberculous Meningitis: A Uniform Case Definition for Use in Clinical Research. The Lancet Infectious Diseases, 10, 803-812.
http://dx.doi.org/10.1016/S1473-3099(10)70138-9
[8] van Well, G.T., Paes, B.F., Terwee, C.B., et al. (2009) Twenty Years of Pediatric Tuberculous Meningitis: A Retrospective Cohort Study in the Western Cape of South Africa. Pediatrics, 123, e1-e8.
http://dx.doi.org/10.1542/peds.2008-1353
[9] Karande, S., Gupta, V., Kulkarni, M. and Joshi, A. (2005) Prognostic Clinical Variables in Childhood Tuberculous Meningitis: An Experience from Mumbai, India. Neurology India, 53, 191-195.
http://dx.doi.org/10.4103/0028-3886.16407
[10] Saitoh, A., Pong, A., Waecker Jr., N.J., Leake, J.A., Nespeca, M.P. and Bradley, J.S. (2005) Prediction of Neurologic Sequelae in Childhood Tuberculous Meningitis: A Review of 20 Cases and Proposal of a Novel Scoring System. The Pediatric Infectious Disease Journal, 24, 207-212.
http://dx.doi.org/10.1097/01.inf.0000154321.61866.2d
[11] Kalita, J., Misra, U.K. and Ranjan, P. (2007) Predictors of Long-Term Neurological Sequelae of Tuberculous Meningitis: A Multivariate Analysis. European Journal of Neurology, 14, 33-37.
http://dx.doi.org/10.1111/j.1468-1331.2006.01534.x
[12] Thwaites, G.E., Bang, N.D., Dung, N.H., Thi Quy, H., Oanh, D.T.T., Cam Thoa, N.T., et al. (2004) Dexamethasone for the Treatment of Tuberculous Meningitis in Adolescents and Adults. New England Journal of Medicine, 351, 1741-1751.
http://dx.doi.org/10.1056/NEJMoa040573
[13] van der Weert, E.M., Hartgers, N.M., Schaaf, H.S., Eley, B.S., Pitcher, R.D., Wieselthaler, N.A., et al. (2006) Comparison of Diagnostic Criteria of Tuberculous Meningitis in Human Immunodeficiency Virus-Infected and Uninfected Children. Pediatric Infectious Disease Journal, 25, 65-69.
http://dx.doi.org/10.1097/01.inf.0000183751.75880.f8
[14] Torok, M.E., Chau, T.T., Mai, P.P., Duy Phong, N., Thi Dung, N., Van Chuong, L., et al. (2008) Clinical and Microbiological Features of HIV-Associated Tuberculous Meningitis in Vietnamese Adults. PLoS ONE, 3, e1772.
[15] Joint Tuberculosis Committee of the British Thoracic Society (1998) Chemotherapy and Management of Tuberculosis in the United Kingdom: Recommendations 1998. Thorax, 53, 536-548.
[16] Blumberg, H.M., Burman, W.J., Chaisson, R.E., et al. (2003) American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: Treatment of Tuberculosis. American Journal of Respiratory and Critical Care Medicine, 167, 603-662.
http://dx.doi.org/10.1164/rccm.167.4.603
[17] Ministry of Health KSA (2011) Health Statistical Year Book. www.moh.gov.sa
[18] Alrajhi, A.A. and Al-Barrak, A.M. (2002) Extrapulmonary Tuberculosis, Epidemiology and Patterns in Saudi Arabia. Saudi Medical Journal, 23, 503-508.
[19] Froude, J.R. and Kingston, M. (1982) Extrapulmonary Tuberculosis in Saudi Arabia, a Review of 162 Cases. King Faisal Specialized Hospital Medical Journal, 2, 85-95.
[20] Al-Otaibi, F. and El Hazmi, M.M. (2010) Extra-Pulmonary Tuberculosis in Saudi Arabia. Indian Journal of Pathology and Microbiology, 53, 227-231.
http://dx.doi.org/10.4103/0377-4929.64327
[21] Kennedy, D.H. and Fallon, R.J. (1979) Tuberculous Meningitis. JAMA, 241, 264-268.
http://dx.doi.org/10.1001/jama.1979.03290290032021
[22] Thwaites, G.E., Chau, T.T.H., Stepniewska, K., Phu, N.H., Chuong, L.V., Sinh, D.X., et al. (2002) Diagnosis of Adult Tuberculous Meningitis by Use of Clinical and Laboratory Features. Lancet, 360, 1287-1292.
http://dx.doi.org/10.1016/S0140-6736(02)11318-3
[23] Alothman, A., Memish, Z.A., Awada, A., Al Mahmood, S., Al Sadoon, S., Rahman, M.M. and Khan, M.Y. (2001) Tuberculous Spondylitis: Analysis of 69 Cases from Saudi Arabia. Spine, 26, 565-570.
http://dx.doi.org/10.1097/00007632-200112150-00020
[24] Marais, S., Thwaites, G., Schoeman, J.F., Torok, M.E., Misra, U.K., Prasad, K., et al. (2010) Tuberculous Meningitis: A Uniform Case Definition for Use in Clinical Research. Lancet Infectious Diseases, 10, 803-812.
http://dx.doi.org/10.1016/S1473-3099(10)70138-9
[25] Toeh, R., Humphries, M.J., Hoare, R.D. and O’Mahony, G. (1989) Clinical Correlation of CT Changes in 64 Chinese Patients with Tuberculous Meningitis. Journal of Neurology, 236, 48-51.
http://dx.doi.org/10.1007/BF00314218
[26] Jie, L. (1988) Computerized Tomography in Tuberculous Meningitis. Chinese Medical Journal, 101, 388-390.
[27] Trautmann, M., Kluge, W., Otto, H.S. and Loddenkemper, R. (1986) Computed Tomography in CNS Tuberculosis. European Neurology, 25, 91-97.
http://dx.doi.org/10.1159/000115993
[28] Kent, S.J., Crowe, S.M., Yung, A., Lucas, C.R. and Mijch, A.M. (1993) Tuberculous Meningitis: A 30-Year Review. Clinical Infectious Diseases, 17, 987-994.
http://dx.doi.org/10.1093/clinids/17.6.987
[29] Sütlas, P.N., Unal, A., Forta, H., Senol, S. and Kirbas, D. (2003) Tuberculous Meningitis in Adults: Review of 61 Cases. Infection, 31, 387-391.
[30] Christensen, A.S.H., Andersen, A.B., Thomsen, V.O., Andersen, P.H. and Johansen, I.S. (2011) Tuberculous Meningitis in Denmark: A Review of 50 Cases. BMC Infectious Diseases, 11, 47.
http://dx.doi.org/10.1186/1471-2334-11-47
[31] Anderson, N.E., Somaratne, J., Mason, D.F., Holland, D. and Thomas, M.G. (2010) A Review of Tuberculous Meningitis at Auckland City Hospital, New Zealand. Journal of Clinical Neuroscience, 17, 1018-1022.
http://dx.doi.org/10.1016/j.jocn.2010.01.007

  
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