scholarly journals Tuberculous Meningitis: a case report of a late diagnosis

2013 ◽  
Vol 12 (1) ◽  
pp. 127
Author(s):  
Bruna Tassi Borille ◽  
Flávia Martinello ◽  
Andressa Verzeletti Rodrigues ◽  
Renata Gonçalves
Keyword(s):  
Tuberculous Meningitis ◽  
Late Onset ◽  
Delayed Diagnosis ◽  
Vascular Wall ◽  
Severe Form ◽  
Late Diagnosis ◽  
University Hospital ◽  
High Morbidity ◽  
Early Treatment Response ◽  
Previous Diagnosis

<div>Introduction: Tuberculous meningitis (TM) is the most severe form of tuberculosis, it has high morbidity and mortality. Once it is diagnosed early, treatment response is excellent. Objective: To report and discuss a case of delayed diagnosis of TM. Methodology: It was selected a case from University Hospital of Federal University of Santa Catarina, the analysis of medical records was performed and discussed based on the scientific literature. Results: It was reported the case of a patient that was diagnosed with leukocytoclastic</div><div>vasculitis (LV) for six months and was admitted presenting granulomatous lung injury, weight loss, fever and dry cough for eigth months. The delay in the diagnosis of tuberculosis (TB) allowed an evolution to TM and the late onset of treatment impaired the patient’s prognosis. It was discussed the vasculitis as a first symptom of tuberculosis, which can occur by deposition of immune complexes</div><div>formed by antibodies against antigens of bacilli in the vascular wall. Conclusions: Previous diagnosis of LV deviated the focus of the case for their cause, and suggested other pathologic conditions, which contributed to delay in the diagnosis of TB. Despite the late diagnosis and treatment, the therapeutic approaches used for vasculitis, TB and TM followed the protocols described in the literature.</div>

scholarly journals OC 8277 IDENTIFICATION OF NEW CEREBROSPINAL FLUID AND BLOOD-BASED BIOMARKERS FOR THE DIAGNOSIS OF TUBERCULOUS MENINGITIS IN CHILDREN

2019 ◽  
Vol 4 (Suppl 3) ◽  
pp. A3.2-A3
Author(s):  
Masilo Charles Manyelo ◽  
Regan S Solomons ◽  
Gerhard Walzl ◽  
Novel N Chegou
Keyword(s):  
Cerebrospinal Fluid ◽  
Tuberculous Meningitis ◽  
Point Of Care ◽  
Extrapulmonary Tuberculosis ◽  
Diagnostic Delay ◽  
Severe Form ◽  
High Morbidity ◽  
Serum Samples ◽  
Meningitis In Children ◽  
Study Participants

BackgroundTuberculous meningitis (TBM) is the most severe form of extrapulmonary tuberculosis (TB). It mostly affects young children and results in high morbidity and mortality, mainly due to diagnostic delay. There is an urgent need for new tests for the earlier and accurate diagnosis of the disease. We previously identified a 3-marker cerebrospinal fluid (CSF) biosignature (VEGF, IL-13, and LL-37) with potential to diagnose TBM. In the present study, we show that CSF and blood-based biosignatures may be useful in the diagnosis of TBM.MethodsCSF and serum samples were consecutively collected from 47 children that were admitted to the Tygerberg Academic Hospital in Cape Town, South Africa, on suspicion of having TBM. Using a multiplex platform, the concentrations of 69 host markers were evaluated in the CSF and serum samples from all the study participants, followed by statistical analysis to ascertain the usefulness of these biomarkers as diagnostic candidates for TBM disease.ResultsOut of the 47 study participants, 23 (48.9%) were finally diagnosed with TBM and 6 (12.8%) were infected with HIV. Several CSF and serum biomarkers showed potential individually as diagnostic candidates for TBM as ascertained by area under the receiver operator characteristics curve (AUC). However, the main findings of our study were the identification of a four-marker CSF biosignature which diagnosed TBM with an AUC of 0.97 (95% CI, 0.92–1.00), and a 3-marker serum biosignature which diagnosed TBM with an AUC of 0.84 (95% CI, 0.73–0.96). We also validated a previously identified 3-marker CSF biosignature (VEGF, IL13 and LL37) in the study.ConclusionCSF and serum biosignatures may be useful in the diagnosis of TBM in children. Our findings require further validation in larger, multi-site studies after which the biosignatures may be incorporated into point-of-care diagnostic tests for TBM.

scholarly journals Potential of host serum protein biosignatures in the diagnosis of tuberculous meningitis in children

2019 ◽  
Author(s):  
Charles M Manyelo ◽  
Regan S Solomons ◽  
Candice I Snyders ◽  
Kim Stanley ◽  
Gerhard Walzl ◽  
...  
Keyword(s):  
Serum Protein ◽  
Tuberculous Meningitis ◽  
Diagnostic Delay ◽  
Final Diagnosis ◽  
Tertiary Hospital ◽  
Severe Form ◽  
Case Definition ◽  
High Morbidity ◽  
Serum Samples ◽  
Improved Performance

AbstractBackgroundTuberculous meningitis (TBM) is the most severe form of tuberculosis and results in high morbidity and mortality in children. Diagnostic delay contributes to the poor outcome. There is an urgent need for new tools for the rapid diagnosis of TBM, especially in children.MethodsWe collected serum samples from children in whom TBM was suspected at a tertiary hospital in Cape Town, South Africa. Children were subsequently classified as having TBM or no TBM using a published uniform research case-definition. Using a multiplex cytokine array platform, we investigated the concentrations of serum biomarkers comprising 7-markers that were previously found to be of value in the diagnosis of adult pulmonary TB (CRP, SAA, CFH, IFN-γ, IP-10, Apo-AI and transthyretin) plus other potentially useful host biomarkers as diagnostic candidates for TBM.FindingsOf 47 children included in the study, 23 (48.9%) had a final diagnosis of TBM of which six had HIV co-infection. A modified version of the adult 7-marker biosignature in which transthyretin was replaced by NCAM1, diagnosed TBM in children with AUC of 0.80 (95% CI, 0.67-0.92), sensitivity of 73.9% (95% CI, 51.6-89.8%) and specificity of 66.7% (95% CI, 44.7-84.4%). A new childhood TBM specific 3-marker biosignature (adipsin, Aβ42 and IL-10) showed potential in the diagnosis of TBM, with AUC of 0.84 (95% CI, 0.73-0.96), sensitivity of 82.6% (95 CI, 61.2-95.0%) and specificity of 75.0% (95% CI, 53.3-90.2%) after leave-one-out cross validation.ConclusionAn adult 7-marker serum protein biosignature showed potential in the diagnosis of TBM in children. However, a smaller childhood TBM-specific biosignature demonstrated improved performance characteristics. Our data indicates that blood-based biomarkers may be useful in the diagnosis of childhood TBM and require further investigation.

scholarly journals Evolving Stroke in Tuberculous Meningitis

2021 ◽  
Author(s):  
Seng Wee Cheo ◽  
Rosdina Zamrud Ahmad Akbar ◽  
Song Weng Ryan Khoo ◽  
Yee Ann Tan ◽  
Qin Jian Low
Keyword(s):  
Tuberculous Meningitis ◽  
Neurological Complication ◽  
Severe Form ◽  
High Morbidity ◽  
Timely Initiation ◽  
Extra Pulmonary Tuberculosis ◽  
Aggressive Disease ◽  
Ct Brain ◽  
The Brain

Tuberculous meningitis (TBM) is the most severe form of extra-pulmonary tuberculosis which carries high mortality with 100% mortality without treatment. A neurological complication of TBM includes hydrocephalus, brain abscess and stroke. In this report, we would like to illustrate a case of stroke in a patient with TBM. In this case, a 37-year old man initially presented with fever for 1 week associated with severe headache and occasional vomiting. Computed tomography (CT) of the brain showed leptomeningeal enhancement and lumbar puncture findings consistent with infective in nature. His MARAIS score was 13 and was treated as tuberculous meningitis with anti-tuberculous therapy. While in the ward, he developed right-sided body weakness with evolving CT brain findings. His condition then stabilized with anti-tuberculous treatment which consists of isoniazid, rifampicin, pyrazinamide and streptomycin. Dexamethasone was also initiated. On follow up, his condition further improves and is functionally independent. In conclusion, tuberculous meningitis is an aggressive disease with high morbidity. Stroke can occur as a result of TBM. Timely initiation of treatment is important in improving the outcome of the patients.

scholarly journals Comparative evaluation of IS6110 and protein antigen b PCR in cerebrospinal fluid for rapid diagnosis of tuberculous meningitis in children

2020 ◽  
Vol 69 (7) ◽  
pp. 979-985
Author(s):  
Sikha Agarwal ◽  
Arushi Gahlot Saini ◽  
Sumeet Dhawan ◽  
Alka Khadwal ◽  
Kusum Sharma ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Tuberculous Meningitis ◽  
Severe Form ◽  
Rapid Diagnosis ◽  
Protein Antigen ◽  
High Morbidity ◽  
Antigen B ◽  
Significant Difference ◽  
Lowenstein Jensen ◽  
Meningitis In Children

Introduction. Childhood tuberculosis meningitis is a severe form of tuberculosis with high morbidity and mortality. The diagnosis is frequently missed and delayed due to lack of sensitive tests like acid-fast bacilli (AFB) smear and delayed results by culture. Aims. To compare the role of IS6110 and protein antigen b PCR in cerebrospinal fluid (CSF) for rapid diagnosis of tuberculous meningitis (TBM) in children. Methodology. Forty-five cases of TBM and 20 controls were enrolled in this prospective study. Results. The mean ages of cases and controls were 4.2±0.5 years and 4.5±0.7 years, respectively. In the TBM group, two-thirds of the children were <4 years of age, and 62 % were males. Sensitivities of AFB smear examination, Löwenstein–Jensen (LJ) medium and bactenecin (BACTEC) culture in cases were 4.4, 0 and 2.2%, respectively. The protein antigen b PCR was most sensitive as it was positive in 35 (77.8 %) of TBM patients; IS6110 PCR was positive in 27 (60 %) patients. Both PCR-based tests had higher positivity than conventional tests and BACTEC culture. No significant difference was seen between the PCR tests. Excellent agreement was observed between both PCR-based tests as they were concordant for 26 positive samples and 35 negative samples. Conclusion. Protein b PCR is a sensitive and rapid method for the diagnosis of TBM (sensitivity 77.8 %). Both PCRs were more sensitive than smear, LJ and BACTEC. The specificity of both PCR was 100 %.

Perinatal Outcome and its Prediction Using Longitudinal Feto-Maternal Doppler Follow-Up in Late Onset Small for Gestational Age Fetuses – A Prospective Cohort Study

2021 ◽  
Author(s):  
Silvia M. Lobmaier ◽  
Oliver Graupner ◽  
Javier U. Ortiz ◽  
Bernhard Haller ◽  
Christina Ried ◽  
...  
Keyword(s):  
Gestational Age ◽  
Small For Gestational Age ◽  
Prospective Cohort ◽  
Perinatal Outcome ◽  
Late Onset ◽  
Induction Of Labor ◽  
University Hospital ◽  
Operative Delivery ◽  
Longitudinal Measurements ◽  
Cesarean Delivery Rate

Abstract Purpose To describe the perinatal outcome of a prospective cohort of late-onset small-for-gestational-age (SGA) fetuses and to test adverse perinatal outcome (APO) prediction using Doppler measurements. Methods Singleton pregnancies from 32 weeks with suspicion of SGA (followed-up each 2 weeks) and randomly selected healthy controls at a university hospital were included. The whole SGA group was divided into the FGR subgroup or SGA percentile 3–10 subgroup. The following Doppler measurements were evaluated prospectively: umbilical artery (UA) pulsatility index (PI), middle cerebral artery (MCA) PI, cerebro-placental ratio (CPR), and mean uterine artery (mUtA) PI. APO was defined as arterial cord blood pH ≤ 7.15 and/or 5-minute Apgar ≤ 7 and/or emergency operative delivery and/or admission to the neonatal unit. Induction of labor was indicated according to a stage-based protocol. Results A total of 149 SGA and 143 control fetuses were included. The number of operative deliveries was similar between both groups (control: 29 %, SGA: 28 %), especially the cesarean delivery rate after the onset of labor (11 % vs. 10 %). Most SGA cases ended up in induction of labor (61 % vs. 31 %, p < 0.001). The areas under the curve (AUC) for APO prediction were similar using the last UA PI, MCA PI, CPR, and mUtA PI and barely reached 0.60. The AUC was best for the FGR subgroup, using the minimal CPR or maximum mUtA PI z-score of all longitudinal measurements (AUC = 0.63). Conclusion SGA fetuses do not have a higher rate of operative delivery if managed according to a risk stratification protocol. Prediction of APO is best for SGA and FGR using the “worst” CPR or mUtA PI but it remains moderate.

Post-thymectomy myasthenia gravis: a case report and systematic review of literature

2021 ◽  
Vol 14 (12) ◽  
pp. e246005
Author(s):  
Louise Gurowich ◽  
Gabriel Yiin ◽  
Adam Maxwell ◽  
Alexandra Rice
Keyword(s):  
Systematic Review ◽  
Case Report ◽  
Myasthenia Gravis ◽  
Early Onset ◽  
Late Onset ◽  
High Morbidity ◽  
Review Of Literature ◽  
Prompt Treatment ◽  
Autoimmune Condition ◽  
Anti Acetylcholine

Myasthenia gravis (MG) is an autoimmune condition affecting the neuromuscular junction characterised by weakness and fatiguability, carrying a high morbidity if treatment is delayed. A clear association with thymoma has led to management with thymectomy as a common practice, but MG presenting post-thymectomy has rarely been reported. We present a case of an 82- year-old woman developing fatigue, ptosis and dysarthria 3 months after thymectomy. After a clinical diagnosis of MG was made, she responded well to prompt treatment with prednisolone and pyridostigmine. Her anti-acetylcholine receptor antibody (anti-AChR) subsequently came back positive. Our systematic review reveals that post-thymectomy MG can be categorised as early-onset or late-onset form with differing aetiology, and demonstrated correlation between preoperative anti-AChR titres and post-thymectomy MG. The postulated mechanisms for post-thymectomy MG centre around long-lasting peripheral autoantibodies. Clinicians should actively look for MG symptoms in thymoma patients and measure anti-AChR preoperatively to aid prognostication.

scholarly journals Absence of Stress Hyperglycemia Indicates the Most Severe Form of Blunt Liver Trauma

Diagnostics ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. 1667
Author(s):  
Janett Kreutziger ◽  
Margot Fodor ◽  
Dagmar Morell-Hofert ◽  
Florian Primavesi ◽  
Stefan Stättner ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Liver Injury ◽  
Injury Severity ◽  
Severe Form ◽  
Liver Trauma ◽  
University Hospital ◽  
Hepatic Insulin Resistance ◽  
Trauma Patients ◽  
Stress Hyperglycemia ◽  
Glucose Levels

Background: Stress hyperglycemia is common in trauma patients. Increasing injury severity and hemorrhage trigger hepatic gluconeogenesis, glycogenolysis, peripheral and hepatic insulin resistance. Consequently, we expect glucose levels to rise with injury severity in liver, kidney and spleen injuries. In contrast, we hypothesized that in the most severe form of blunt liver injury, stress hyperglycemia may be absent despite critical injury and hemorrhage. Methods: All patients with documented liver, kidney or spleen injuries, treated at a university hospital between 2000 and 2020 were charted. Demographic, laboratory, radiological, surgical and other data were analyzed. Results: A total of 772 patients were included. In liver (n = 456), spleen (n = 375) and kidney (n = 152) trauma, an increase in injury severity past moderate to severe (according to the American Association for the Surgery of Trauma, AAST III-IV) was associated with a concomitant rise in blood glucose levels independent of the affected organ. While stress-induced hyperglycemia was even more pronounced in the most severe forms (AAST V) of spleen (median 10.7 mmol/L, p < 0.0001) and kidney injuries (median 10.6 mmol/L, p = 0.004), it was absent in AAST V liver injuries, where median blood glucose level even fell (5.6 mmol/L, p < 0.0001). Conclusions: Absence of stress hyperglycemia on hospital admission could be a sign of most severe liver injury (AAST V). Blood glucose should be considered an additional diagnostic criterion for grading liver injury.

Characteristics of Pediatric Stroke and Association of Delayed Diagnosis with Mortality in a Mexican Tertiary Care Hospital

2021 ◽  
Author(s):  
Gerardo Garza-Alatorre ◽  
Ana Luisa Carrion-Garcia ◽  
Alfredo Falcon-Delgado ◽  
Elda Carolina Garza-Davila ◽  
Angel R Martinez-Ponce de Leon ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hemorrhagic Stroke ◽  
Early Recognition ◽  
Tertiary Care ◽  
Delayed Diagnosis ◽  
University Hospital ◽  
Pediatric Stroke ◽  
Care Hospital ◽  
Continuous Increase ◽  
Common Risk Factors

Abstract Background and objectives Pediatric cerebrovascular disease carries significant morbidity and mortality. Early recognition of a pediatric stroke as well and its most common risk factors are important, but that diagnosis is often delayed. It is believed that the incidence in our center is higher than it appears. This study aims to assess the incidence and characteristics of the pediatric stroke in our university hospital. Likewise, this study seeks to evaluate if a longer symptoms-to-diagnosis time is associated with mortality in patients with ischemic stroke. Methods A retrospective study including children with stroke admitted to the UANL University Hospital from January 2013 to December 2016. Results A total of 41 patients and 46 stroke episodes were admitted. About 45.7% had an ischemic stroke and 54.3% had a hemorrhagic stroke. A mortality of 24.4% and a morbidity of 60.9% were recorded. Regarding ischemic and hemorrhagic stroke, an increased symptoms-to-diagnosis time and a higher mortality were obtained with a relative risk of 2.667 (95% confidence interval [CI]: 1.09–6.524, p = 0.013) and 8.0 (95% CI: 2.18–29.24, p = < 0.0001), respectively. A continuous increase in the incidence rate, ranging from 4.57 to 13.21 per 1,000 admissions comparing the first period (2013) versus the last period (2016), p = 0.02, was found in our center. Conclusions Pediatric stroke is a rare disease; however, its incidence shows a continuous increase. More awareness toward pediatric stroke is needed.

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