scholarly journals Miliary Brain Tuberculomas and Meningitis: Tuberculosis Beyond the Lungs

2020 ◽  
Author(s):  
Gisela Vasconcelos ◽  
Ligia Santos ◽  
Catarina Couto ◽  
Margarida Cruz ◽  
Alice Castro
Keyword(s):  
Central Nervous System ◽  
Cerebrospinal Fluid ◽  
Nervous System ◽  
Mycobacterium Tuberculosis ◽  
Infectious Diseases ◽  
Miliary Tuberculosis ◽  
Central Nervous System Involvement ◽  
Total Recovery ◽  
Prompt Diagnosis ◽  
Timely Treatment

Tuberculosis remains one of the most common infectious diseases. Miliary presentation is a rare and possibly lethal form, resulting from massive lymphohaematogenous dissemination of Mycobacterium tuberculosis bacilli. The authors describe the case of a 47-year-old immunocompetent woman, diagnosed with miliary tuberculosis, with both lung and central nervous system involvement, who showed total recovery after starting anti-tuberculous drugs. The atypical neutrophilic-predominant pleocytosis and negative cerebrospinal fluid microbiological results made the diagnosis even more challenging. Since prognosis largely depends on timely treatment, recognition and prompt diagnosis is important. Thus, clinicians should be aware and treatment should be initiated as soon as the diagnosis is suspected.

scholarly journals Fatal central nervous system co-infection with SARS-CoV-2 and tuberculosis in a healthy child

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Bishara J. Freij ◽  
Bassam M. Gebara ◽  
Rabail Tariq ◽  
Ay-Ming Wang ◽  
John Gibson ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Cerebrospinal Fluid ◽  
Nervous System ◽  
Mycobacterium Tuberculosis ◽  
Tuberculous Infection ◽  
Local Health ◽  
Imaging Findings ◽  
Brain Herniation ◽  
Radiographic Findings ◽  
Cerebellar Tissue

Abstract Background Central and peripheral nervous system symptoms and complications are being increasingly recognized among individuals with pandemic SARS-CoV-2 infections, but actual detection of the virus or its RNA in the central nervous system has rarely been sought or demonstrated. Severe or fatal illnesses are attributed to SARS-CoV-2, generally without attempting to evaluate for alternative causes or co-pathogens. Case presentation A five-year-old girl with fever and headache was diagnosed with acute SARS-CoV-2-associated meningoencephalitis based on the detection of its RNA on a nasopharyngeal swab, cerebrospinal fluid analysis, and magnetic resonance imaging findings. Serial serologic tests for SARS-CoV-2 IgG and IgA showed seroconversion, consistent with an acute infection. Mental status and brain imaging findings gradually worsened despite antiviral therapy and intravenous dexamethasone. Decompressive suboccipital craniectomy for brain herniation with cerebellar biopsy on day 30 of illness, shortly before death, revealed SARS-CoV-2 RNA in cerebellar tissue using the Centers for Disease Control and Prevention 2019-nCoV Real-Time Reverse Transcriptase-PCR Diagnostic Panel. On histopathology, necrotizing granulomas with numerous acid-fast bacilli were visualized, and Mycobacterium tuberculosis complex DNA was detected by PCR. Ventricular cerebrospinal fluid that day was negative for mycobacterial DNA. Tracheal aspirate samples for mycobacterial DNA and culture from days 22 and 27 of illness were negative by PCR but grew Mycobacterium tuberculosis after 8 weeks, long after the child’s passing. She had no known exposures to tuberculosis and no chest radiographic findings to suggest it. All 6 family members had normal chest radiographs and negative interferon-γ release assay results. The source of her tuberculous infection was not identified, and further investigations by the local health department were not possible because of the State of Michigan-mandated lockdown for control of SARS-CoV-2 spread. Conclusion The detection of SARS-CoV-2 RNA in cerebellar tissue and the demonstration of seroconversion in IgG and IgA assays was consistent with acute SARS-CoV-2 infection of the central nervous infection. However, the cause of death was brain herniation from her rapidly progressive central nervous system tuberculosis. SARS-CoV-2 may mask or worsen occult tuberculous infection with severe or fatal consequences.

scholarly journals Coinfection withCryptococcus GattiiandMycobacterium Tuberculosisin an Otherwise Healthy 18-Year-Old Woman

2011 ◽  
Vol 18 (4) ◽  
pp. e62-e63 ◽  
Author(s):  
Lindsay Van Tongeren ◽  
Tawimas Shaipanich ◽  
John A Fleetham
Keyword(s):  
Central Nervous System ◽  
Cerebrospinal Fluid ◽  
Nervous System ◽  
Mycobacterium Tuberculosis ◽  
Immune System ◽  
Medical History ◽  
Healthy Individual ◽  
Host Immune System ◽  
Healthy Young Woman ◽  
History Of

A case ofCryptococcus gattii(pulmonary and central nervous system) andMycobacterium tuberculosis(pulmonary) coinfection in an otherwise healthy young woman is reported. The patient presented with a two-month history of dry cough. She had an unremarkable medical history. Both tuberculosis and cryptococcosis were diagnosed following bronchoscopy, and a subsequent lumbar puncture revealedC gattiiin the cerebrospinal fluid. There is evidence that bothM tuberculosisandC gattiimay have suppressive effects on the host immune system. This suggests a mechanism by which an otherwise healthy individual developed these two infections.

Central nervous system involvement in goats undergoing primary infections with Trypanosoma brucei and relapse infections after chemotherapy

Parasitology ◽  
1985 ◽  
Vol 90 (2) ◽  
pp. 255-268 ◽  
Author(s):  
D. D. Whitelaw ◽  
J. E. Moulton ◽  
W. I. Morrison ◽  
M. Murray
Keyword(s):  
Central Nervous System ◽  
Drug Resistance ◽  
Cerebrospinal Fluid ◽  
Nervous System ◽  
Drug Treatment ◽  
Trypanosoma Brucei ◽  
Central Nervous System Involvement ◽  
Severe Illness ◽  
Cellular Infiltration ◽  
The Central Nervous System

Relapse of infection after trypanocidal drug treatment of trypanosome infections is normally attributed to drug resistance on the part of the parasite, under-dosage of the drug, or reinfection of the host. We have demonstrated relapse infections in goats arising from none of these. Fourteen goats infected with Trypanosoma brucei suffered severe illness and 3 died within 45 days. Despite treatment with the trypanocidal drug Berenil, a 4th goat died 2 days later. Recovery of the remainder followed chemotherapy, and in 2 goats, necropsiecl 45 days after treatment, no trypanosomes or abnormalities were detected. However 2–3 months after Berenil chemotherapy, despite trypanosomes being undetectable in the blood during the intervening period, infections in 4 of the remaining 8 animals relapsed. At all stages of the primary and relapse infections, trypanosomes isolated from the blood of the goats were completely susceptible to Berenil when tested in mice, as were parasites isolated from cerebrospinal fluid and brain tissue at necropsy. At the time of treatment, only minimal cellular infiltration was found in the central nervous system (CNS), but death from the relapse infection was associated with a very severe meningoencephalitis. We conclude that the relapse infections were caused by the re-emergence of trypanosornes from the CNS, where sequestered parasites were inaccessible to the trypanocidal effects of the drug.

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