Diagnostic challenges of central nervous system tuberculosis

Area of Science:

• Neurology
• Infectious Diseases
• Public Health

Background:

• Central nervous system tuberculosis (CNS TB) is a severe form of extrapulmonary TB.
• Diagnosis of CNS TB can be challenging, especially in atypical presentations.
• The California Encephalitis Project (CEP) serves as a surveillance system for encephalitis cases.

Purpose of the Study:

• To identify cases of CNS TB within the California Encephalitis Project.
• To describe the clinical features and diagnostic challenges associated with CNS TB.
• To highlight the importance of considering CNS TB in unexplained encephalitis.

Main Methods:

• Retrospective review of 20 CNS TB cases referred to the CEP.
• Analysis of clinical presentations, diagnostic test results, and patient demographics.
• Evaluation of factors contributing to diagnostic delays.

Main Results:

• CNS TB was identified in 20 cases of unexplained encephalitis.
• Atypical features such as encephalitic symptoms, rapid onset, and specific age groups were noted.
• Diagnostic challenges included insensitive cerebrospinal fluid (CSF) TB PCR, normal CSF glucose in diabetics, and negative tuberculin skin tests.

Conclusions:

• CNS TB should be considered in the differential diagnosis of unexplained encephalitis, even with atypical presentations.
• Standard diagnostic tools for TB may be insufficient for CNS TB.
• Improved diagnostic strategies are needed for timely identification and management of CNS TB.