Predictors of neurologic deficit on discharge and in-hospital mortality of pediatric tuberculous meningitis patients with hydrocephalus who undergo ventriculoperitoneal shunting

2017 ◽  
Vol 21 ◽  
pp. e111
Author(s):  
Ariel C. Rabanes ◽  
Martha Lu-Bolaños
Keyword(s):  
Hospital Mortality ◽  
Tuberculous Meningitis ◽  
Neurologic Deficit ◽  
Ventriculoperitoneal Shunting

Standard versus sequential anti-tubercular treatment in patients with tuberculous meningitis: a randomized controlled trial

2020 ◽  
Author(s):  
Usha Kant Misra ◽  
Mritunjai Kumar ◽  
Jayantee Kalita
Keyword(s):  
Randomized Controlled Trial ◽  
Hospital Mortality ◽  
Tuberculous Meningitis ◽  
Controlled Trial ◽  
Hospital Death ◽  
Inclusion Criteria ◽  
Open Label ◽  
Drug Induced ◽  
Standard Regimen ◽  
Randomized Controlled

Abstract Background To compare the safety and efficacy of sequential anti-tubercular treatment (ATT) regimen with the standard regimen in tuberculous meningitis (TBM). Methods This single-centre, open-label, parallel group randomized controlled trial was conducted from May 2017 to June 2019 in India. Treatment-naïve patients with TBM fulfilling the inclusion criteria were randomized to four drug ATT regimens (rifampicin, isoniazid, ethambutol and pyrazinamide) administered either simultaneously (standard arm) or one after another (sequential arm) in a 1 : 1 ratio. The primary endpoint was drug-induced hepatitis (DIH) and the secondary endpoints were in-hospital death and disability at 3 and 6 months using a modified Rankin Scale. Results A total of 97 patients with TBM were recruited; 15 did not meet the inclusion criteria and 2 refused to participate. The median age of the patients was 26 y (range 15–75) and 37 (46.2%) were males. The patients in the sequential arm had fewer cases of DIH (20% vs 42.5%; p=0.03). The patients in the sequential arm had lower in-hospital mortality (2.5% vs 17.5%; p=0.025) and better 6-month outcomes (25.0% vs 50.0%; p=0.02) compared with the standard arm. Conclusions Sequential ATT was associated with a lower frequency of DIH, lower in-hospital mortality and better 6-month outcome. Trial registration Clinical Trials Registry of India (ctri.nic.in) identifier: REF/2016/09/012214/CTRI/2017/10/010072.

scholarly journals Performance of Lipoarabinomannan Assay using Cerebrospinal fluid for the diagnosis of Tuberculous meningitis among HIV patients

2019 ◽  
Vol 4 ◽  
pp. 123 ◽  
Author(s):  
Richard Kwizera ◽  
Fiona V. Cresswell ◽  
Gerald Mugumya ◽  
Micheal Okirwoth ◽  
Enock Kagimu ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Hospital Mortality ◽  
Tuberculous Meningitis ◽  
Diagnostic Performance ◽  
Poor Performance ◽  
Case Definition ◽  
Hiv Positive ◽  
Diagnostic Utility ◽  
Uniform Case ◽  
Mycobacteria Tuberculosis

Background: The diagnostic utility of the Mycobacteria tuberculosis lipoarabinomannan (TB-LAM) antigen lateral flow assay on cerebrospinal fluid (CSF) for the diagnosis of tuberculous meningitis (TBM) has not been extensively studied and the few published studies have conflicting results. Methods: Lumbar CSF from 59 HIV-positive patients with suspected TBM was tested with TB-LAM and Xpert MTB/Rif Ultra. The diagnostic performance of CSF TB-LAM was compared to positive CSF Xpert MTB/Rif Ultra (definite TBM) and a composite reference of probable or definite TBM according to the uniform case definition.  Results: Of 59 subjects, 12 (20%) had definite TBM and five (9%) had probable TBM. With reference to definite TBM, CSF TB-LAM assay had a diagnostic sensitivity of 33% and specificity of 96%. When compared to a composite reference of definite or probable TBM, the sensitivity was 24% and specificity was 95%. There were two false positive tests with TB-LAM (3+ grade). In-hospital mortality in CSF TB-LAM positive patients was 17% compared to 0% in those with definite TBM by Xpert MTB/Rif Ultra but negative LAM. Conclusions: Lumbar CSF TB-LAM has a poor performance in diagnosing TBM. Both urine TB-LAM and Xpert Ultra should be further investigated in the diagnosis of TBM.

Management of Hydrocephalus Resulting from Acoustic Neuromas

1993 ◽  
Vol 109 (6) ◽  
pp. 1020-1024 ◽  
Author(s):  
Robert J. S. Briggs ◽  
Clough Shelton ◽  
Jed A. Kwartler ◽  
William Hitselberger
Keyword(s):  
Obstructive Hydrocephalus ◽  
Cerebrospinal Fluid Leak ◽  
Neurologic Deficit ◽  
Tumor Removal ◽  
Ventriculoperitoneal Shunts ◽  
Safe Method ◽  
Acoustic Neuromas ◽  
Ventriculoperitoneal Shunting ◽  
Fluid Leak ◽  
Culture Positive

Patients with large acoustic neuromas may have secondary obstructive hydrocephalus and occasionally significant neurologic deficit develops. At the House Ear Clinic, we have managed patients with hydrocephalus by translabyrinthine tumor removal without preoperative ventriculoperitoneal shunting. Forty-three patients with documented hydrocephalus who underwent acoustic neuroma removal have been reviewed. Six patients had neurologic deficit resulting from raised Intracranial pressure before surgery. In each of these six cases, the deficit resolved after tumor removal without requiring shunting. Two patients had had ventriculoperitoneal shunts inserted because of neurologic deficit before referral for tumor removal. Two other patients underwent postoperative shunting for neurologic deficit — One at 2 weeks and one at 2 years. Cerebral or cerebellar herniation was not noted in any case. Cerebrospinal fluid leak occurred In five patients (11.6%) and culture-positive meningitis in two patients (4.6%). We conclude that decompression by translabyrinthine tumor removal is a safe method of management for patients with hydrocephalus resulting from large acoustic tumors.

scholarly journals Performance of Lipoarabinomannan Assay using Cerebrospinal fluid for the diagnosis of Tuberculous meningitis among HIV patients

2019 ◽  
Vol 4 ◽  
pp. 123 ◽  
Author(s):  
Richard Kwizera ◽  
Fiona V. Cresswell ◽  
Gerald Mugumya ◽  
Micheal Okirwoth ◽  
Enock Kagimu ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Hospital Mortality ◽  
Tuberculous Meningitis ◽  
Diagnostic Performance ◽  
Poor Performance ◽  
Case Definition ◽  
Hiv Positive ◽  
Diagnostic Utility ◽  
Uniform Case ◽  
Mycobacteria Tuberculosis

Background: The diagnostic utility of the Mycobacteria tuberculosis lipoarabinomannan (TB-LAM) antigen lateral flow assay on cerebrospinal fluid (CSF) for the diagnosis of tuberculous meningitis (TBM) has not been extensively studied and the few published studies have conflicting results. Methods: Lumbar CSF from 59 HIV-positive patients with suspected TBM was tested with TB-LAM and Xpert MTB/Rif Ultra. The diagnostic performance of CSF TB-LAM was compared to positive CSF Xpert MTB/Rif Ultra (definite TBM) and a composite reference of probable or definite TBM according to the uniform case definition.  Results: Of 59 subjects, 12 (20%) had definite TBM and five (9%) had probable TBM. With reference to definite TBM, CSF TB-LAM assay had a diagnostic sensitivity of 33% and specificity of 96%. When compared to a composite reference of definite or probable TBM, the sensitivity was 24% and specificity was 95%. There were two false positive tests with TB-LAM (3+ grade). In-hospital mortality in CSF TB-LAM positive patients was 17% compared to 0% in those with definite TBM by Xpert MTB/Rif Ultra but negative LAM. Conclusions: Lumbar CSF TB-LAM has a poor performance in diagnosing TBM. Both urine TB-LAM and Xpert Ultra should be further investigated in the diagnosis of TBM.

scholarly journals Tuberculous meningitis diagnosis and outcomes during the Xpert MTB/Rif era: a 6.5-year cohort study in Uganda

2018 ◽  
Vol 3 ◽  
pp. 64 ◽  
Author(s):  
Fiona V. Cresswell ◽  
Ananta S. Bangdiwala ◽  
Nathan C. Bahr ◽  
Emily Trautner ◽  
Edwin Nuwagira ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Tuberculous Meningitis ◽  
Media Culture ◽  
Sub Saharan Africa ◽  
Smear Microscopy ◽  
Prospective Cohorts ◽  
Sub Saharan ◽  
Tb Diagnostics ◽  
Post Hoc ◽  
The Impact

Background: Tuberculous meningitis (TBM), a leading cause of meningitis in sub-Saharan Africa, is notoriously difficult to diagnose. In our Ugandan setting TB diagnostics have evolved rapidly in recent years, with introduction of Xpert MTB/Rif (Xpert) in 2011 and culture in 2013. We aim to describe the impact of improved TBM diagnostics at two Ugandan hospitals between 2010 and 2017. Methods: Adults presenting with meningitis (headache and objective meningism) were assessed for eligibility for enrolment in two consecutive trials investigating cryptococcal meningitis. Cohort one received cerebrospinal fluid (CSF) smear microscopy only (2010-2013). Cohort two received smear microscopy and Xpert on 1ml unprocessed CSF at physician discretion (2011-2013). Cohort three received smear microscopy, routine liquid-media culture and Xpert on large volume CSF (2013-2017) for all meningitis suspects with a negative CSF cryptococcal antigen (crAg). In a post-hoc analysis of three prospective cohorts, we compare rates of microbiologically confirmed TBM and hospital outcomes over time. Results: 1672 predominantly HIV-infected adults underwent lumbar puncture, of which 33% (558/1672) had negative CSF crAg and 12% (195/1672) were treated for TBM. Over the study period, microbiological confirmation of TBM increased from 3% to 41% (P<0.01) and there was a decline in in-hospital mortality from 57% to 41% (P=0.27). Adjusting for definite TBM and antiretroviral therapy, and using imputed data, the odds of dying were nearly twice as high in cohort one (adjusted odds ratio 1.7, 95% CI 0.7 to 4.4) compared to cohort three.  Sensitivity of Xpert was 63% (38/60) and culture was 65% (39/60) against a composite reference standard. Conclusions: Since 2010, as TBM diagnostics have evolved, microbiologically-confirmed TBM diagnoses have increased significantly. There has been a non-significant decline in TBM in-hospital mortality but due to multiple possible confounding factors it is not possible to conclude what has driven this decline in mortality.

scholarly journals Cryptococcal Meningitis and Tuberculous Meningitis Co-infection in HIV-Infected Ugandan Adults

2018 ◽  
Vol 5 (8) ◽  
Author(s):  
Jayne Ellis ◽  
Fiona V Cresswell ◽  
Joshua Rhein ◽  
Kenneth Ssebambulidde ◽  
David R Boulware
Keyword(s):  
Hospital Mortality ◽  
Tuberculous Meningitis ◽  
Cryptococcal Meningitis ◽  
Hiv Therapy ◽  
Prompt Diagnosis

Abstract We report 5 HIV-infected Ugandan adults with cryptococcal and tuberculous (TB) meningitis co-infection. All unmasked meningitis occurred within 5 weeks of starting HIV therapy. Xpert MTB/RIF Ultra facilitated prompt diagnosis; however, 60% in-hospital mortality occurred. TB meningitis coinfection prevalence was 0.8% (5/586) among cryptococcal meningitis, 2 during second cryptococcal episodes.

scholarly journals Tuberculous meningitis with good outcome following appropriate timing of ventriculoperitoneal shunting for hydrocephalus

2022 ◽  
Vol 9 (1) ◽  
Author(s):  
Junzo Nakao ◽  
Keishi Fujita ◽  
Kazuhiro Ishii ◽  
Yoshimitsu Akutsu ◽  
Takuma Hara ◽  
...  
Keyword(s):  
Tuberculous Meningitis ◽  
Good Outcome ◽  
Ventriculoperitoneal Shunting

scholarly journals Can improved diagnostics reduce mortality from Tuberculous meningitis? Findings from a 6.5-year cohort in Uganda

2018 ◽  
Vol 3 ◽  
pp. 64 ◽  
Author(s):  
Fiona V. Cresswell ◽  
Ananta S. Bangdiwala ◽  
Nathan C. Bahr ◽  
Emily Trautner ◽  
Edwin Nuwagira ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Tuberculous Meningitis ◽  
Media Culture ◽  
Sub Saharan Africa ◽  
Smear Microscopy ◽  
Cryptococcal Antigen ◽  
Referral Hospitals ◽  
Sub Saharan ◽  
The Impact ◽  
Composite Reference Standard

Background: Tuberculous meningitis (TBM) is the second most common cause of meningitis in sub-Saharan Africa and is notoriously difficult to diagnose. We describe the impact of improved TBM diagnostics over 6.5 years at two Ugandan referral hospitals. Methods: Cohort one received cerebrospinal fluid (CSF) smear microscopy only (2010-2013). Cohort two received smear microscopy and Xpert MTB/Rif (Xpert) on 1ml unprocessed CSF at physician discretion (2011-2013). Cohort three received smear microscopy, routine liquid-media culture and Xpert on large volume centrifuged CSF (2013-2017) for all meningitis suspects with a negative CSF cryptococcal antigen. We compared rates of microbiologically confirmed TBM and hospital outcomes over time. Results: 1672 HIV-infected adults presenting with suspected meningitis underwent lumbar puncture, of which 33% (558/1672) had negative CSF cryptococcal antigen and 12% (195/1672) were treated for TB meningitis. Over the study period, microbiological confirmation of TBM increased from 3% to 41% (P<0.01) and there was a decline in in-hospital mortality from 57% to 41% (P=0.27) amongst those with a known outcome. Adjusting for definite TBM diagnosis and antiretroviral therapy use, and using imputed data, assuming 50% of those with an unknown outcome died, the odds of dying were nearly twice as high in cohort one (adjusted odds ratio 1.7, 95% CI 0.7 to 4.4) compared to cohort three.  Sensitivity of Xpert was 63% (38/60) and culture was 65% (39/60) against a composite reference standard. Conclusions: As TBM diagnostics have improved, microbiologically-confirmed TBM diagnoses have increased and in-hospital mortality has declined. Yet, mortality due to TB meningitis remains unacceptably high and further measures are needed to improve outcomes from TBM in Uganda.

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