Management of intracranial tuberculous mass lesions: how long should we treat for? [version 2; peer review: 1 approved, 2 approved with reservations]
Tuberculous intracranial mass lesions are common in settings with high tuberculosis (TB) incidence and HIV prevalence. The diagnosis of such lesions, which include tuberculoma and tuberculous abscesses, is often presumptive and based on radiological features, supportive evidence of TB elsewhere and...
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| Format: | Article |
| Language: | English |
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Wellcome
2019-10-01
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| Series: | Wellcome Open Research |
| Online Access: | https://wellcomeopenresearch.org/articles/4-158/v2 |
| _version_ | 1818190247495729152 |
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| author | Suzaan Marais Ronald Van Toorn Felicia C. Chow Abi Manesh Omar K. Siddiqi Anthony Figaji Johan F. Schoeman Graeme Meintjes Tuberculous Meningitis International Research Consortium |
| author_facet | Suzaan Marais Ronald Van Toorn Felicia C. Chow Abi Manesh Omar K. Siddiqi Anthony Figaji Johan F. Schoeman Graeme Meintjes Tuberculous Meningitis International Research Consortium |
| author_sort | Suzaan Marais |
| collection | DOAJ |
| description | Tuberculous intracranial mass lesions are common in settings with high tuberculosis (TB) incidence and HIV prevalence. The diagnosis of such lesions, which include tuberculoma and tuberculous abscesses, is often presumptive and based on radiological features, supportive evidence of TB elsewhere and response to TB treatment. However, the treatment response is unpredictable, with lesions frequently enlarging paradoxically or persisting for many years despite appropriate TB treatment and corticosteroid therapy. Most international guidelines recommend a 9-12 month course of TB treatment for central nervous system TB when the infecting Mycobacterium tuberculosis (M.tb) strain is sensitive to first-line drugs. However, there is variation in opinion and practice with respect to the duration of TB treatment in patients with tuberculomas or tuberculous abscesses. A major reason for this is the lack of prospective clinical trial evidence. Some experts suggest continuing treatment until radiological resolution of enhancing lesions has been achieved, but this may unnecessarily expose patients to prolonged periods of potentially toxic drugs. It is currently unknown whether persistent radiological enhancement of intracranial tuberculomas after 9-12 months of treatment represents active disease, inflammatory response in a sterilized lesion or merely revascularization. The consequences of stopping TB treatment prior to resolution of lesional enhancement have rarely been explored. These important issues were discussed at the 3rd International Tuberculous Meningitis Consortium meeting. Most clinicians were of the opinion that continued enhancement does not necessarily represent treatment failure and that prolonged TB therapy was not warranted in patients presumably infected with M.tb strains susceptible to first-line drugs. In this manuscript we highlight current medical treatment practices, benefits and disadvantages of different TB treatment durations and the need for evidence-based guidelines regarding the treatment duration of patients with intracranial tuberculous mass lesions. |
| first_indexed | 2024-12-11T23:55:41Z |
| format | Article |
| id | doaj.art-42408d4199bb4ff3a2233b0cfcf079e7 |
| institution | Directory Open Access Journal |
| issn | 2398-502X |
| language | English |
| last_indexed | 2024-12-11T23:55:41Z |
| publishDate | 2019-10-01 |
| publisher | Wellcome |
| record_format | Article |
| series | Wellcome Open Research |
| spelling | doaj.art-42408d4199bb4ff3a2233b0cfcf079e72022-12-22T00:45:21ZengWellcomeWellcome Open Research2398-502X2019-10-01410.12688/wellcomeopenres.15501.217008Management of intracranial tuberculous mass lesions: how long should we treat for? [version 2; peer review: 1 approved, 2 approved with reservations]Suzaan Marais0Ronald Van Toorn1Felicia C. Chow2Abi Manesh3Omar K. Siddiqi4Anthony Figaji5Johan F. Schoeman6Graeme Meintjes7Tuberculous Meningitis International Research ConsortiumDepartment of Neurology, Inkosi Albert Luthuli Central Hospital and University of KwaZulu-Natal, Durban, 4091, South AfricaDepartment of Pediatrics and Child Health, Stellenbosch University, Cape Town, 7505, South AfricaWeill Institute of Neurosciences and Department of Neurology and Division of Infectious Diseases, University of California, San Francisco, California, 94110, USADepartment of Infectious Diseases, Christian Medical College, Vellore, 632004, IndiaDepartment of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, 02215, USADivision of Neurosurgery and Neuroscience institute, University of Cape Town, Cape Town, 7700, South AfricaDepartment of Pediatrics and Child Health, Stellenbosch University, Cape Town, 7505, South AfricaWellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, Department of Medicine, University of Cape Town, Cape Town, 7925, South AfricaTuberculous intracranial mass lesions are common in settings with high tuberculosis (TB) incidence and HIV prevalence. The diagnosis of such lesions, which include tuberculoma and tuberculous abscesses, is often presumptive and based on radiological features, supportive evidence of TB elsewhere and response to TB treatment. However, the treatment response is unpredictable, with lesions frequently enlarging paradoxically or persisting for many years despite appropriate TB treatment and corticosteroid therapy. Most international guidelines recommend a 9-12 month course of TB treatment for central nervous system TB when the infecting Mycobacterium tuberculosis (M.tb) strain is sensitive to first-line drugs. However, there is variation in opinion and practice with respect to the duration of TB treatment in patients with tuberculomas or tuberculous abscesses. A major reason for this is the lack of prospective clinical trial evidence. Some experts suggest continuing treatment until radiological resolution of enhancing lesions has been achieved, but this may unnecessarily expose patients to prolonged periods of potentially toxic drugs. It is currently unknown whether persistent radiological enhancement of intracranial tuberculomas after 9-12 months of treatment represents active disease, inflammatory response in a sterilized lesion or merely revascularization. The consequences of stopping TB treatment prior to resolution of lesional enhancement have rarely been explored. These important issues were discussed at the 3rd International Tuberculous Meningitis Consortium meeting. Most clinicians were of the opinion that continued enhancement does not necessarily represent treatment failure and that prolonged TB therapy was not warranted in patients presumably infected with M.tb strains susceptible to first-line drugs. In this manuscript we highlight current medical treatment practices, benefits and disadvantages of different TB treatment durations and the need for evidence-based guidelines regarding the treatment duration of patients with intracranial tuberculous mass lesions.https://wellcomeopenresearch.org/articles/4-158/v2 |
| spellingShingle | Suzaan Marais Ronald Van Toorn Felicia C. Chow Abi Manesh Omar K. Siddiqi Anthony Figaji Johan F. Schoeman Graeme Meintjes Tuberculous Meningitis International Research Consortium Management of intracranial tuberculous mass lesions: how long should we treat for? [version 2; peer review: 1 approved, 2 approved with reservations] Wellcome Open Research |
| title | Management of intracranial tuberculous mass lesions: how long should we treat for? [version 2; peer review: 1 approved, 2 approved with reservations] |
| title_full | Management of intracranial tuberculous mass lesions: how long should we treat for? [version 2; peer review: 1 approved, 2 approved with reservations] |
| title_fullStr | Management of intracranial tuberculous mass lesions: how long should we treat for? [version 2; peer review: 1 approved, 2 approved with reservations] |
| title_full_unstemmed | Management of intracranial tuberculous mass lesions: how long should we treat for? [version 2; peer review: 1 approved, 2 approved with reservations] |
| title_short | Management of intracranial tuberculous mass lesions: how long should we treat for? [version 2; peer review: 1 approved, 2 approved with reservations] |
| title_sort | management of intracranial tuberculous mass lesions how long should we treat for version 2 peer review 1 approved 2 approved with reservations |
| url | https://wellcomeopenresearch.org/articles/4-158/v2 |
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