scholarly journals Tuberculous meningitis – clinical and laboratory review of 100 patients

1986 ◽  
Vol 96 (2) ◽  
pp. 231-238 ◽  
Author(s):  
M. E. Kilpatrick ◽  
N. I. Girgis ◽  
M. W. Yassin ◽  
A. A. Abu El Ella
Keyword(s):  
Central Nervous System ◽  
Tuberculous Meningitis ◽  
Clinical Course ◽  
Laboratory Data ◽  
Severity Of Illness ◽  
X Rays ◽  
Antituberculous Therapy ◽  
Mortality And Morbidity ◽  
Neurologic Sequelae ◽  
Physical Findings

SUMMARYIn developing countries tuberculous meningitis is a difficult infection to differentiate from other central nervous system (CNS) infections. This paper presents the history, physical findings, laboratory data, and clinical course of 100 patients who were admitted to a special ward and had CSF cultures positive for Mycobacterium tuberculosis. Fifty-four patients were comatose when admitted and 76 had meningeal signs. Mean admission CSF values were WBC 531, glucose 23 mg/dl, and protein 166 mg/dl. Only two CSF AFB smears were positive. Sixty-one percent of the chest X-rays taken were consistent with pulmonary tuberculous and 39% were normal. Twenty-four patients died within the first week after admission, before the clinical diagnosis was made and anti-tuberculous therapy could be started. Fifty-three of 76 patients given antituberculous therapy died. Neurologic sequelae developed in 48% of the survivors. The high mortality and morbidity rates in this patient-group were due to the severity of illness on admission and the predominance of children (54%).

scholarly journals TUBERCULOUS MENINGITIS;

2017 ◽  
Vol 24 (06) ◽  
pp. 865-868
Author(s):  
Sabir Ali ◽  
Adil Mahmood ◽  
Muhammad Fayyaz ◽  
Faiza Naseem
Keyword(s):  
Central Nervous System ◽  
Cerebrospinal Fluid ◽  
Tuberculous Meningitis ◽  
Neurological Deficits ◽  
Significant Morbidity ◽  
Mortality And Morbidity ◽  
Clinical Criteria ◽  
Cerebrospinal Fluid Examination ◽  
The Mean ◽  
Cns Tuberculosis

Background: Central nervous system (CNS) tuberculosis constitutes 6% of alltuberculosis cases and tuberculous meningitis (TBM) is the most serious manifestation. Despiteeffective anti-tuberculous medicines, 20-50% of tuberculous patients die and significant numberof patients have neurological deficits. Failure to initiate anti-tuberculous therapy in the earlystages of the disease may lead to significant morbidity and mortality. Setting: MW-1, MW-III andMW-IV of Bahawal Victoria hospital Bahawalpur. Methods: All patients of tuberculous meningitisdiagnosed on the basis of the clinical criteria and cerebrospinal fluid examination (WBC ≥15,predominant lymphocytes and sugar level ≤40 mg/dl) were included in the study. Age, gender,and GCS level of the patients were recorded. Every patient was observed for mortality withintwo weeks after admission (within ward or enquired on mobile phone if patient was dischargedearly). Results: A total of 73 patients were included in the study. The mean age of patientswas 36.71 years with standard deviation of 17.161 years. Out of 73 patients, 31 (42.47%)patients were male and 42 (57.53%) were female. Out of 73 patients, 12 (16.44%) patients oftuberculous meningitis had mortality while 61 (83.56%) patients had no mortality. Conclusion:Tuberculous meningitis is a chronic illness with relatively high mortality and morbidity. Low levelof consciousness on admission to hospital is an important predictor for mortality.

scholarly journals Clinical and intestinal histopathological findings in SARS-CoV-2/COVID-19 patients with hematochezia

2020 ◽  
Author(s):  
Margaret Cho ◽  
Weiguo Liu ◽  
Sophie Balzora ◽  
Yvelisse Suarez ◽  
Deepthi Hoskoppal ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Clinical Course ◽  
Laboratory Data ◽  
Ischemic Injury ◽  
Medication History ◽  
Elderly Male ◽  
Acute Phase Reactants ◽  
Mortality And Morbidity ◽  
Histopathological Findings ◽  
Gi Symptoms

Gastrointestinal (GI) symptoms of SARS-CoV2/COVID-19 in the form of anorexia,nausea, vomiting, abdominal pain and diarrhea are usually preceeded by respiratory manifestations and are associated with a poor prognosis. Hematochezia is an uncommon clinical presentation of COVID-19 disease and we hypothesize that older patients with significant comorbidites (obesity and cardiovascular) and prolonged hospitalization are suspectible to ischemic injury to the bowel. We reviewed the clinical course, key laboratory data including acute phase reactants, drug/medication history in two elderly male patients admitted for COVID-19 respiratory failure. Both patients had a complicated clinical course and suffered from hematochezia and acute blood loss anemia requiring blood transfusion around day 40 of their hospitalization. Colonoscopic impressions were correlated with the histopathological findings in the colonic biopies and changes compatible with ischemia to nonspecific acute inflammation, edema and increased eosinophils in the lamina propria were noted.Both patients were on anticoagulants, multiple antibiotics and antifungal agents due to respiratory infections at the time of lower GI bleeding. Hematochezia resolved spontaneously with supportive care. Both patients eventually recovered and were discharged. Elderly patients with significant comorbid conditions are uniquely at risk for ischemic injury to the bowel. Hypoxic conditions due to COVID-19 pneumonia and respiratory failure, compounded by preexisting cardiovascular complications, and/or cytokine storm orchestrated by the viral infection leading to alteration in coagulation profile and/or drug/medication injury can be difficult to distinguish in these critically ill patients. Presentation of hematochezia may further increase the mortality and morbidity of COVID-19 patients, and prompt consultation and management by gastroenterology is therefore warranted.

Treatment of Central Nervous System Tuberculosis

2018 ◽  
Vol 13 (02) ◽  
pp. 141-152
Author(s):  
Amina Ahmed
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Tuberculous Meningitis ◽  
Diagnosis And Treatment ◽  
Duration Of Treatment ◽  
Standard Regimen ◽  
Mortality And Morbidity ◽  
Improved Outcomes ◽  
Prompt Diagnosis ◽  
Optimal Regimen

AbstractCentral nervous system tuberculosis (CNS-TB) manifests as tuberculous meningitis, intracranial tuberculoma, or spinal tuberculous arachnoiditis. Children are disproportionately affected, with high rates of mortality and morbidity reported even in the era of treatment. Most guidelines for the treatment of drug-susceptible CNS-TB recommend 9 to 12 months of a standard regimen of isoniazid, rifampin, pyrazinamide, and ethambutol, with the adjunctive use of corticosteroids early in therapy. Recent trials have demonstrated improved outcomes with intensified regimens using nonstandard regimens or higher dosages of standard drugs. Accumulating evidence also supports shorter duration of treatment. Further investigation is warranted to identify the optimal regimen and duration of treatment for CNS-TB. Complications such as hydrocephalus may be managed medically or surgically. Although outcomes have improved with effective chemotherapy and immunomodulation of disease, prompt diagnosis and treatment in the early stages of disease remain paramount to improve prognosis.

scholarly journals Standardized approaches for clinical sampling and endpoint ascertainment in tuberculous meningitis studies

2020 ◽  
Vol 4 ◽  
pp. 204
Author(s):  
Ursula K Rohlwink ◽  
Felicia C Chow ◽  
Sean Wasserman ◽  
Sofiati Dian ◽  
Rachel PJ Lai ◽  
...  
Keyword(s):  
Tuberculous Meningitis ◽  
Science Research ◽  
Clinical Samples ◽  
Pharmacokinetic Studies ◽  
Sampling Strategies ◽  
Antituberculous Therapy ◽  
Mortality And Morbidity ◽  
Resource Limited ◽  
Severe Manifestation ◽  
Practical Recommendations

Tuberculous meningitis (TBM), the most severe manifestation of tuberculosis, has poorly understood immunopathology and high mortality and morbidity despite antituberculous therapy. This calls for accelerated clinical and basic science research in this field. As TBM disproportionally affects poorer communities, studies are often performed in resource-limited environments, creating challenges for data collection and harmonisation. Comparison of TBM studies has been hampered by variation in sampling strategies, study design and choice of study endpoints.  Based on literature review and expert consensus, this paper provides firstly, practical recommendations to enable thorough diagnostic, pathophysiological and pharmacokinetic studies using clinical samples, and facilitates better data aggregation and comparisons across populations and settings. Secondly, we discuss clinically relevant study endpoints, including neuroimaging, functional outcome, and cause of death, with suggestions of how these could be applied in different designs for future TBM studies.

scholarly journals Standardized approaches for clinical sampling and endpoint ascertainment in tuberculous meningitis studies

2019 ◽  
Vol 4 ◽  
pp. 204 ◽  
Author(s):  
Ursula K Rohlwink ◽  
Felicia C Chow ◽  
Sean Wasserman ◽  
Sofiati Dian ◽  
Rachel PJ Lai ◽  
...  
Keyword(s):  
Tuberculous Meningitis ◽  
Science Research ◽  
Clinical Samples ◽  
Pharmacokinetic Studies ◽  
Sampling Strategies ◽  
Antituberculous Therapy ◽  
Mortality And Morbidity ◽  
Resource Limited ◽  
Severe Manifestation ◽  
Practical Recommendations

Tuberculous meningitis (TBM), the most severe manifestation of tuberculosis, has poorly understood immunopathology and high mortality and morbidity despite antituberculous therapy. This calls for accelerated clinical and basic science research in this field. As TBM disproportionally affects poorer communities, studies are often performed in resource-limited environments, creating challenges for data collection and harmonisation. Comparison of TBM studies has been hampered by variation in sampling strategies, study design and choice of study endpoints.  Based on literature review and expert consensus, this paper provides firstly, practical recommendations to enable thorough diagnostic, pathophysiological and pharmacokinetic studies using clinical samples, and facilitates better data aggregation and comparisons across populations and settings. Secondly, we discuss clinically relevant study endpoints, including neuroimaging, functional outcome, and cause of death, with suggestions of how these could be applied in different designs for future TBM studies.

Six Cases of Leukaemia After Irradiation

1962 ◽  
Vol 2 (01) ◽  
pp. 80-86
Author(s):  
S. Plesničar ◽  
S. Modic ◽  
B. Cernelč
Keyword(s):  
Clinical Course ◽  
Relevant Information ◽  
X Rays

SummaryThe authors describe six cases of leukaemia in patients exposed to X-rays. Clinical course and blood values are given. All known details are submitted, since it is extremely important to gather all relevant information in cases of this kind.

scholarly journals Increased insulin resistance in intensive care: longitudinal retrospective analysis of glycaemic control patients in a New Zealand ICU

2021 ◽  
Vol 12 ◽  
pp. 204201882110121
Author(s):  
Jennifer L. Knopp ◽  
J. Geoffrey Chase ◽  
Geoffrey M. Shaw
Keyword(s):  
Insulin Resistance ◽  
Insulin Sensitivity ◽  
Glycaemic Control ◽  
Diagnostic Category ◽  
Severity Of Illness ◽  
Insulin Metabolism ◽  
Mortality And Morbidity ◽  
Risk Of Death ◽  
Severity Scores ◽  
High Insulin

Background: Critical care populations experience demographic shifts in response to trends in population and healthcare, with increasing severity and/or complexity of illness a common observation worldwide. Inflammation in critical illness impacts glucose–insulin metabolism, and hyperglycaemia is associated with mortality and morbidity. This study examines longitudinal trends in insulin sensitivity across almost a decade of glycaemic control in a single unit. Methods: A clinically validated model of glucose–insulin dynamics is used to assess hour–hour insulin sensitivity over the first 72 h of insulin therapy. Insulin sensitivity and its hour–hour percent variability are examined over 8 calendar years alongside severity scores and diagnostics. Results: Insulin sensitivity was found to decrease by 50–55% from 2011 to 2015, and remain low from 2015 to 2018, with no concomitant trends in age, severity scores or risk of death, or diagnostic category. Insulin sensitivity variability was found to remain largely unchanged year to year and was clinically equivalent (95% confidence interval) at the median and interquartile range. Insulin resistance was associated with greater incidence of high insulin doses in the effect saturation range (6–8 U/h), with the 75th percentile of hourly insulin doses rising from 4–4.5 U/h in 2011–2014 to 6 U/h in 2015–2018. Conclusions: Increasing insulin resistance was observed alongside no change in insulin sensitivity variability, implying greater insulin needs but equivalent (variability) challenge to glycaemic control. Increasing insulin resistance may imply greater inflammation and severity of illness not captured by existing severity scores. Insulin resistance reduces glucose tolerance, and can cause greater incidence of insulin saturation and resultant hyperglycaemia. Overall, these results have significant clinical implications for glycaemic control and nutrition management.

scholarly journals Hypoalbuminemia on Admission as an Independent Risk Factor for Acute Functional Decline after Infection

Nutrients ◽  
2020 ◽  
Vol 13 (1) ◽  
pp. 26
Author(s):  
Hidehiko Nakano ◽  
Hideki Hashimoto ◽  
Masaki Mochizuki ◽  
Hiromu Naraba ◽  
Yuji Takahashi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Barthel Index ◽  
Nutritional Assessment ◽  
Functional Decline ◽  
Laboratory Data ◽  
Severity Of Illness ◽  
Multivariable Logistic Regression Analysis ◽  
Need For Care ◽  
Assessment Indicator ◽  
Basic Characteristics

The risk of acute functional decline increases with age, and concepts including frailty and post-acute care syndrome have been proposed; however, the effects of the nutritional status currently remain unclear. Patients admitted to the emergency department of Hitachi General Hospital for infectious diseases between April 2018 and May 2019 were included. To identify risk factors for functional decline at discharge, defined as Barthel Index <60, we investigated basic characteristics, such as age, sex, disease severity, the pre-morbid care status, and cognitive impairment, as well as laboratory data on admission, including albumin as a nutritional assessment indicator. In total, 460 surviving patients out of 610 hospitalized for infection were analyzed. In a multivariable logistic regression analysis, factors independently associated with Barthel Index <60 at discharge were age (adjusted OR 1.03, 95%CI 1.01–1.06, p = 0.022), serum albumin (adjusted OR: 0.63, 95%CI: 0.41–0.99, p = 0.043), and the need for care prior to admission (adjusted OR: 5.92, 95%CI: 3.15–11.15, p < 0.001). Hypoalbuminemia on admission in addition to age and the need for care prior to admission were identified as risk factors for functional decline in patients hospitalized for infection. Functional decline did not correlate with the severity of illness.

scholarly journals A Rare Complication of Tuberculous Meningitis Pediatric Anterior Glenohumeral Instability

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Kerem Bilsel ◽  
Mehmet Erdil ◽  
Mehmet Elmadag ◽  
Hasan H. Ceylan ◽  
Derya Celik ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Tuberculous Meningitis ◽  
Shoulder Instability ◽  
Rare Complication ◽  
Central Nervous System Infection ◽  
Arthroscopic Stabilization ◽  
Anterior Instability ◽  
Glenohumeral Instability ◽  
Rehabilitation Protocols ◽  
Anterior Glenohumeral Instability

Dislocation and instability of the shoulder joint are rare occurrences in childhood. Traumatic, infectious, congenital, and neuromuscular causes of pediatric recurrent shoulder dislocations are reported before. Central nervous system infection in infancy may be a reason for shoulder instability during childhood. This situation, which causes a disability for children, can be treated successfully with arthroscopic stabilization of the shoulder and postoperative effective rehabilitation protocols. Tuberculous meningitis may be a reason for neuromuscular shoulder instability. We describe a 12-year-old child with a recurrent anterior instability of the shoulder, which developed after tuberculous meningitis at 18 months of age. We applied arthroscopic treatment and stabilized the joint.

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