Correction: A scoring system to effectively evaluate central nervous system tuberculosis in patients with miliary tuberculosis

Aim. To study clinical and epidemiological aspects of pathomorphosis of extrapulmonary tuberculosis clinical forms. Materials and Methods. Retrospective analysis of 138 case histories in children aged to 15 years, obtaining extrapulmonary tuberculosis treatment in a specialized children's hospital during 1988-2015 was carried out. Among them, in 103 children, clinical forms of extrapulmonary tuberculosis combined with respiratory tuberculosis and in 35 children independent forms of extrapulmonary tuberculosis were found. Studied stage (1988-2015) was divided into 3 periods: I – 1988-1997, II – 1998-2007, III – 2008-2015. During 2008-2015, incomparison to previous periods, the number of cases of peripheral lymph node tuberculosis (PLN), meninges and central nervous system tuberculosis, bones and joints tuberculosis, and ocular tuberculosis decreased. In 2008-2015, the share of combined forms of meninges and central nervous system tuberculosis and ocular tuberculosis remained at 1998-2007 level. During 2008-2015, skin tuberculosis was not diagnosed. Nevertheless, in 2008-2015, in6.8±10.2 % of cases extrapulmonary tuberculosis combined with miliary tuberculosis, and in 5.8±10.4 % of cases the process characterized by lethal outcome, moreover 4.9±10.7% from them – in recent years. It is important that during period I, in 19.6±13.2 % of cases extrapulmonary tuberculosis combined with respiratory tuberculosis in reverse development phases, during period II – in 12.9±19.3 % of cases, during period III – in 23.8±21.2 % of cases. Conclusion. Despite the reduction, extrapulmonary tuberculosis combined with severe forms of respiratory tuberculosis, which led to lethal outcome in children in 5.8±10.4% of cases. Tuberculosis epidemiological situation worsening, reversion of severe forms of tuberculosis with the development of extrapulmonary one and several organs injuries in children shows the necessity of social, preventive and therapeutic measures intensification among children.

Download Full-text

Extremely High Levels of Central Nervous System Involvement in Miliary Tuberculosis

10.21203/rs.3.rs-696092/v1 ◽

2021 ◽

Author(s):

Guirong Wang ◽

Ruixia Liang ◽

Qing Sun ◽

Xinlei Liao ◽

Chenqian Wang ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Miliary Tuberculosis ◽

Central Nervous System Involvement ◽

Cns Involvement ◽

Molecular Tests ◽

Cerebral Computed Tomography ◽

Magnetic Resonance Imaging Mri ◽

Almost All ◽

Csf Examination

Abstract BackgroundMiliary tuberculosis (TB) is one of the severest manifestations of TB that can be lethal when concomitant with the central nervous system (CNS) involvement. Bacteriological, biochemical and radiological methods for find CNS comorbidity in miliary TB was evaluated in this study.MethodsConsecutive miliary TB adults were retrospectively enrolled from two designated TB hospitals in China. The capacities of examinations of cerebrospinal fluid (CSF), cerebral computed tomography (CT) and magnetic resonance imaging (MRI) for diagnosis of CNS involvement were assessed.ResultsAssessment of CNS involvement with a lumbar puncture and/or neuroimaging was undertaken in 282 out of 392 of acute miliary TB. Of these 282 patients, 87.59% (247/282) had CNS involvement. Cerebral contrast-enhanced MRI (96.05%, 170/177) and MRI (93.15%, 204/219) yielded significantly higher sensitivities over CSF examination (71.92%, 146/203, P<0.001) and CT (34.69%, 17/49, P<0.001). The sensitivity of CSF examination was superior to CT scan (P<0.001). Although 59.65% (134/225) miliary TB patients acquired bacteriological evidence with sputum examination, the positivity was only 8.82% (21/238) for CSF examination by conventional and molecular tests.ConclusionAlmost all miliary TB had CNS involvement and MRI demonstrated outstanding potential over other methods. Therefore, a routinely screening of CNS TB should be strongly suggested in miliary TB and MRI could be used as the initial approach in resources rich settings.

Download Full-text

Development and Validation of a New Scoring System for the Early Diagnosis of Tuberculous Meningitis in Adults

10.21203/rs.3.rs-31333/v1 ◽

2020 ◽

Author(s):

Yuying LU ◽

Chen ZHANG ◽

Zhongyang HU ◽

Guang YAO ◽

Qinghua ZHANG ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Tuberculous Meningitis ◽

Scoring System ◽

Clinical Laboratory ◽

Early Stage ◽

Characteristic Curve ◽

Clinical Manifestations ◽

Symptom Duration ◽

Diagnostic Score

Abstract Background The absence of a sufficiently accurate and efficient diagnosis of tuberculous meningitis (TBM) is major obstacle to delayed treatment, and its non-specific clinical manifestations easily mimic the central nervous system infections caused by other causes, including virus, bacteria, and cryptococcus. This study aims to develop and validate a diagnostic score system for TBM in HIV-uninfected adults by simultaneously comparing TBM with viral meningitis (VM), bacterial meningitis (BM), and cryptococcal meningitis (CM). Methods Twenty-nine factors (including clinical, laboratory and imaging) were assessed among 382 patients who satisfied inclusion criteria for TBM (n = 113), VM (n = 143), BM (n = 65) and CM (n = 61). Independent predictors for the diagnosis of TBM were obtained by logistic regression to establish a diagnostic scoring system. The performance of this scoring system was evaluated using a prospective validation cohort. Results Nine factors independently associated with the diagnosis of TBM: symptom duration (10–30 days), systemic symptoms, evidence of extra-central nervous system tuberculosis, cerebrospinal fluid (CSF) leukocyte count (100-500∗106 /mL), CSF neutrophil proportion (20%-75%), CSF protein (> 1 g/L), low serum sodium (< 137 mmol/L), meningeal enhancement, and brain parenchymal nodules (tuberculomas). The CSF neutrophil proportion was assigned a score of 2 and all other factors were assigned a score of 1. A score of at least five was suggestive of TBM with a sensitivity of 85.8% and a specificity of 87.7%, and the area under the receiver operating characteristic curve (AUC) was 0.927. When applied prospectively to an additional 72 patients (21 with TBM, 27 with VM, 14 with BM, and 10 with CM), the sensitivity, specificity, accuracy, and AUC values of this scoring model were 90.5%, 86.3%, 87.5%, and 0.944, respectively. Conclusions For differential diagnosis between TBM and other causes of meningitis (VM,CM and BM), we developed and validated a new weighted scoring system. The application of this scoring system can help diagnose TBM more efficiently in the early stage.

Download Full-text

Pediatric miliary tuberculosis presenting with stroke: contribution to the paper “Tuberculosis of the central nervous system in children”

Child s Nervous System ◽

10.1007/s00381-019-04270-5 ◽

2019 ◽

Vol 35 (8) ◽

pp. 1273-1275

Author(s):

María Isabel Sánchez-Códez ◽

Manuel Lubián-Gutiérrez ◽

Carmen Fernández-Bravo ◽

Myriam Ley-Martos

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Miliary Tuberculosis ◽

The Central Nervous System

Download Full-text

KANET Test: Experience of Zagreb Group

Donald School Journal of Ultrasound in Obstetrics & Gynecology ◽

10.5005/jp-journals-10009-1239 ◽

2012 ◽

Vol 6 (2) ◽

pp. 166-170

Author(s):

Ana Tikvica ◽

Berivoj Miskovic ◽

Maja Predojevic ◽

Davor Ivankovic

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Scoring System ◽

Obstet Gynecol ◽

Three Dimensional ◽

Neurological Status ◽

Developmental Pathway ◽

New Scoring

ABSTRACT A new scoring system for the assessment of fetal neurological status, Kurjak antenatal neurodevelopmental test (KANET), has been recently published in several journals. Test is based on prenatal assessment of fetal behavior by three-dimensional/fourdimensional (3D/4D) sonography. Assessment of fetal behavior gave a promising opportunity to understand the hidden function of the developmental pathway of the fetal central nervous system. This new test has been proposed by the Zagreb group based on the several years of research. In this review we present the most significant results of the Zagreb group which led to construction of KANET test, basic presumptions of the KANET, and our published results on KANET. How to cite this article Miskovic B, Predojevic M, Stanojevic M, Tikvica A, Kurjak A, Ivankovic D, Vasilj O. KANET Test: Experience of Zagreb Group. Donald School J Ultrasound Obstet Gynecol 2012;6(2):166-170.

Download Full-text