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Tuberculosis
1Service of Neurology, Hospital de Galdacano, Galdacano, Vizcaya, Spain.
Abstract:
Tuberculosis remains a serious health problem worldwide, particularly affecting the poorest in both high-income and developing countries. It was declared a global emergency by the World Health Organization in 1993. Central nervous system (CNS) tuberculosis is caused by mycobacteria belonging to the Mycobacterium tuberculosis complex, and is acquired through inhalation of aerosolized droplet nuclei. Meningitis represents the most frequent and severe form of CNS tuberculosis. Parenchymal CNS involvement can occur in the form of tuberculoma or, more rarely, abscess. Also, damage of the spinal cord, roots, and spine can occur in the form of spinal meningitis, radiculomyelitis, spondylitis, or spinal cord infarction. Diagnosis remains a challenge due to the slow growth of the organisms and the low yield of cerebrospinal fluid cultures, as well as the frequent absence of evidence of infection elsewhere. This results in frequent empirical therapy, based on a combination of four drugs (isoniazid, rifampicin, pyrazinamide and ethambutol) for 2 months, followed by 10 additional months with two drugs (isoniazid and rifampicin) to a total duration of 12 months. Shorter regimens have also been successful, but there have been few controlled trials in patients with extrapulmonary disease. Corticoid therapy seems to be associated with a reduced risk of death, and is usually indicated. Evidence of multidrug resistance requires variable combinations of first- and second-line drugs; fortunately, resistance does not seem to represent a serious threat for CNS tuberculosis at present, but still requires the utmost vigilance.
Insights
Central nervous system tuberculosis is a severe global health issue. Diagnosis is challenging, often requiring empirical treatment and vigilance against drug resistance.
Area of Science:
- Neurology
- Infectious Diseases
- Public Health
Background:
- Tuberculosis (TB) is a major global health concern, declared a World Health Organization emergency in 1993.
- Central nervous system (CNS) tuberculosis, caused by Mycobacterium tuberculosis, is a severe manifestation acquired via inhalation.
- Meningitis is the most common and serious form of CNS TB, with parenchymal involvement and spinal cord damage also occurring.
Purpose of the Study:
- To review the challenges and current approaches in diagnosing and treating Central Nervous System (CNS) tuberculosis.
- To highlight the diagnostic difficulties and standard therapeutic regimens for CNS TB.
- To discuss the role of adjunctive therapies and the implications of drug resistance.
Main Methods:
- Review of existing literature on CNS tuberculosis diagnosis and treatment.
- Analysis of diagnostic challenges, including slow organism growth and low culture yields.
- Evaluation of standard and shorter therapeutic regimens, and the use of corticosteroids.
Main Results:
- Diagnosis of CNS TB is difficult due to microbiological limitations and often requires empirical treatment.
- Standard therapy involves a 12-month regimen of four drugs initially, followed by two.
- Corticosteroid therapy is associated with reduced mortality, and multidrug resistance, while not currently a major threat, necessitates careful monitoring.
Conclusions:
- CNS tuberculosis presents significant diagnostic and therapeutic challenges.
- Current treatment relies on prolonged multi-drug regimens, with corticosteroids often indicated.
- Vigilance regarding drug resistance is crucial despite its current low prevalence in CNS TB.
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