Challenges in the diagnosis of tuberculous meningitis
Tuberculosis (TB) continues to pose a significant public health problem. Tuberculous meningitis (TBM) is the most severe form of extra-pulmonary TB. TBM carries a high mortality rate, including for those receiving treatment for TB. Diagnosis of TBM is difficult for clinicians as it can clinically pr...
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| Format: | Article |
| Language: | English |
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Elsevier
2020-08-01
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| Series: | Journal of Clinical Tuberculosis and Other Mycobacterial Diseases |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405579420300280 |
| _version_ | 1819085805266665472 |
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| author | Carlo Foppiano Palacios Paul G. Saleeb |
| author_facet | Carlo Foppiano Palacios Paul G. Saleeb |
| author_sort | Carlo Foppiano Palacios |
| collection | DOAJ |
| description | Tuberculosis (TB) continues to pose a significant public health problem. Tuberculous meningitis (TBM) is the most severe form of extra-pulmonary TB. TBM carries a high mortality rate, including for those receiving treatment for TB. Diagnosis of TBM is difficult for clinicians as it can clinically present similarly to other forms of meningitis. The difficulty in diagnosis often leads to a delay in treatment and subsequent mortality. Those who survive are left with long-term sequelae leading to lifelong disability. The microbiologic diagnosis of TBM requires the isolation of Mycobacterium tuberculosis from the cerebrospinal fluid (CSF) of an infected patient. The diagnosis of tuberculous meningitis continues to be challenging for clinicians. Unfortunately, many cases of TBM cannot be confirmed based on clinical and imaging findings as the clinical findings are nonspecific, while laboratory techniques are largely insensitive or slow. Until recently, the lack of accessible and timely tests has contributed to a delay in diagnosis and subsequent morbidity and mortality for many patients, particularly those in resourcelimited settings. The availability of Xpert Ultra and point-of-care lipoarabinomannan (LAM) testing could represent a new era of prompt diagnosis and early treatment of tuberculous meningitis. However, clinicians must be cautious when ruling out TBM with Xpert Ultra due to its low negative predictive value. Due to the limitations of current diagnostics, clinicians should utilize a combination of diagnostic modalities in order to prevent morbidity in patients with TBM. |
| first_indexed | 2024-12-21T21:10:11Z |
| format | Article |
| id | doaj.art-15ce0278ab704d63a60811699267ed8a |
| institution | Directory Open Access Journal |
| issn | 2405-5794 |
| language | English |
| last_indexed | 2024-12-21T21:10:11Z |
| publishDate | 2020-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Clinical Tuberculosis and Other Mycobacterial Diseases |
| spelling | doaj.art-15ce0278ab704d63a60811699267ed8a2022-12-21T18:50:10ZengElsevierJournal of Clinical Tuberculosis and Other Mycobacterial Diseases2405-57942020-08-0120100164Challenges in the diagnosis of tuberculous meningitisCarlo Foppiano Palacios0Paul G. Saleeb1Departments of Internal Medicine and Pediatrics, University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201, United States; Corresponding author at: Department of Medicine, 22 S Greene St, Baltimore, MD 21201, United States.Institute of Human Virology, University of Maryland School of Medicine, 725 W Lombard St, Baltimore, MD 21201, United StatesTuberculosis (TB) continues to pose a significant public health problem. Tuberculous meningitis (TBM) is the most severe form of extra-pulmonary TB. TBM carries a high mortality rate, including for those receiving treatment for TB. Diagnosis of TBM is difficult for clinicians as it can clinically present similarly to other forms of meningitis. The difficulty in diagnosis often leads to a delay in treatment and subsequent mortality. Those who survive are left with long-term sequelae leading to lifelong disability. The microbiologic diagnosis of TBM requires the isolation of Mycobacterium tuberculosis from the cerebrospinal fluid (CSF) of an infected patient. The diagnosis of tuberculous meningitis continues to be challenging for clinicians. Unfortunately, many cases of TBM cannot be confirmed based on clinical and imaging findings as the clinical findings are nonspecific, while laboratory techniques are largely insensitive or slow. Until recently, the lack of accessible and timely tests has contributed to a delay in diagnosis and subsequent morbidity and mortality for many patients, particularly those in resourcelimited settings. The availability of Xpert Ultra and point-of-care lipoarabinomannan (LAM) testing could represent a new era of prompt diagnosis and early treatment of tuberculous meningitis. However, clinicians must be cautious when ruling out TBM with Xpert Ultra due to its low negative predictive value. Due to the limitations of current diagnostics, clinicians should utilize a combination of diagnostic modalities in order to prevent morbidity in patients with TBM.http://www.sciencedirect.com/science/article/pii/S2405579420300280TuberculosisMeningitisCNSDiagnosisDiagnosticsTuberculoma |
| spellingShingle | Carlo Foppiano Palacios Paul G. Saleeb Challenges in the diagnosis of tuberculous meningitis Journal of Clinical Tuberculosis and Other Mycobacterial Diseases Tuberculosis Meningitis CNS Diagnosis Diagnostics Tuberculoma |
| title | Challenges in the diagnosis of tuberculous meningitis |
| title_full | Challenges in the diagnosis of tuberculous meningitis |
| title_fullStr | Challenges in the diagnosis of tuberculous meningitis |
| title_full_unstemmed | Challenges in the diagnosis of tuberculous meningitis |
| title_short | Challenges in the diagnosis of tuberculous meningitis |
| title_sort | challenges in the diagnosis of tuberculous meningitis |
| topic | Tuberculosis Meningitis CNS Diagnosis Diagnostics Tuberculoma |
| url | http://www.sciencedirect.com/science/article/pii/S2405579420300280 |
| work_keys_str_mv | AT carlofoppianopalacios challengesinthediagnosisoftuberculousmeningitis AT paulgsaleeb challengesinthediagnosisoftuberculousmeningitis |