[Acute toxic encephalopathy in patients with tuberculosis]

Area of Science:

• Neurology
• Infectious Diseases
• Pulmonology

Context:

• Tuberculosis (TB) patients admitted to Moscow Tuberculosis Hospital No. 7 with disseminated and progressive forms were studied.
• Neurological disorders, particularly acute toxic encephalopathy (ATE), are severe complications in TB patients.
• Patients often present with critical illness, disseminated lung lesions, and high rates of multidrug-resistant TB.

Purpose:

• To investigate the factors contributing to the development of ATE in patients with severe tuberculosis.
• To highlight the diagnostic challenges of ATE in TB patients, differentiating it from tuberculous meningitis.
• To outline the specific treatment strategies for ATE in the context of advanced, drug-resistant TB.

Summary:

• ATE in TB is driven by tuberculous toxemia (often with alcohol co-intoxication) causing vasculitis and DIC, and cerebral hypoxia from cardiopulmonary failure.
• Diagnosis is challenging, requiring exclusion of tuberculous meningitis, and is supported by acute progression, normal cerebrospinal fluid, coagulopathy, and DIC.
• Treatment involves intensive antitubercular therapy (parenteral) and DIC management, yet mortality remains high (35.6%) due to disease severity and multidrug resistance (29.6%).

Impact:

• This study underscores the critical nature of ATE in advanced TB and the diagnostic difficulties it presents.
• Findings emphasize the need for integrated management of neurological complications, toxemia, and drug-resistant TB.
• High mortality and treatment ineffectiveness highlight the urgent need for improved therapeutic approaches for TB-associated neurological disorders.