Jurnal Meningitis TB 1

8/17/2019 Jurnal Meningitis TB 1

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Copyright © 2013 SciRes. NM

101 Neuroscience & Medicine, 2013, 4, 101-107http://dx.doi.org/10.4236/nm.201 3.42016 Pu!ished "n!ine #une 2013 $htt p ://%%%.scirp.or g /&our n' !/nm(

Tuberculous Meningitis: Diagnostic and Radiological

Features, Pathogenesis and io!ar"ers#

Mei-$ing %haron Tai

)ep'rtment o* +edicine, -'cu!ty o* +edicine, niersity o* +'!'y', u'!' umpur, +'!'ysi'.

m'i!: sh'ront 1 0gm'i!.com

Receied -eru'ry 12th

, 20135 reised +'rch 26th

, 20135 'ccepted pri! 27th

, 2013

Copyright © 2013 +ei8ing Sh'ron 9'i. 9his is 'n open 'ccess 'rtic!e distriuted under the Cre'tie Commons ttriution icense,%hich permits unrestricted use, distriution, 'nd reproduction in 'ny medium, proided the origin'! %or is proper!y cited.

&%TR&'T

Centr'! nerous system tuercu!osis is the most seere *orm o* extr'pu!mon'ry tuercu!osis dise'se. ;e 'im to reie%the di'gnostic 'nd r'dio!ogic'! *e'tures, p'thogenesis, 'nd iom'rers o* tuercu!ous meningitis. ;e '!so 'im to !oo 't

the !'test dee!opment o* rese'rch o* the dise'se. 9he di'gnosis o* tuercu!ous $9- !ee!, c'sp'se81 'nd @81 β . Sig8

n'!8regu!'tory protein '!ph' is oerexpressed 't mR? !ee!. =igh dose intr'enous ri*'mpicin $B00 mg d'i!y( is 'sso8

ci'ted %ith reduced mort'!ity in p'tients %ith 'd'nced dise'se.

(e)*ords: 9uercu!ous +eningitis5 9


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1029uercu!ous +eningitis: )i'gnostic 'nd R'dio!ogic'! -e'tures, P'thogenesis 'nd


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9uercu!ous +eningitis: )i'gnostic 'nd R'dio!ogic'! -e'tures, P'thogenesis 'nd


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's comp'red to on!y 11F occurred in the @S HoneQ sup8

p!ied y !'ter'! stri'te, 'nterior choroid'! 'nd th'!'mo8

genicu!'te 'rteries D23E. @n p'tients %ith @S, 2F o*

stroes occurred in the @S Hone, 2F in the sucortic'!

%hite m'tter, 'nd 24F in the cerer'! cortex D23E. "n!y

11F occurred in the 9< Hone D23E.

+R@ *e'tures o* stroe due to 9


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1049uercu!ous +eningitis: )i'gnostic 'nd R'dio!ogic'! -e'tures, P'thogenesis 'nd -( !ee! D33E. @ncre'se in

>- !ee! is 'ssoci'ted %ith shorter dur'tion o* i!!ness,

+R@ *e'tures o* stroe, 'nd p'r'doxic'! response D33E.

@n summ'ry, iom'rers such 's 9?-8α, @86, @810,

@-?8'!ph' 'nd @-?8g'mm' 'id %ith the di'gnosis o* 9<

meningitis.

2+.+ Treat!ent and Manage!ent

Prompt di'gnosis 'nd e'r!y tre'tment 're cruci'! D7E. )e8

cision to st'rt 'ntituercu!ous tre'tment is o*ten empiric'!D7E. ;=" guide!ines recommend ' 6 months course o*

'ntituercu!ous tre'tment5 ho%eer, other guide!ines

recommend ' pro!onged tre'tment extended to or 12

months D7E. 9he recent


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9uercu!ous +eningitis: )i'gnostic 'nd R'dio!ogic'! -e'tures, P'thogenesis 'nd !'sgo% com'

sc'!e L B on 'dmission, 'ge o* T30 ye'rs 'nd presence o*

hydroceph'!us %ith entricu!o8peritone'! shunt %'s sig8

ni*ic'nt!y 'ssoci'ted %ith mort'!ity D41E. 9here %'s in8

cre'sed mort'!ity 'ccording to CS !ee! D43E. Cognitie imp'irment is

signi*ic'nt!y 'ssoci8 'ted %ith exud'tes 'nd tuercu!om's

D42E. +otor de*icits 're signi*ic'nt!y corre!'ted %ith

stroes D42E.

Positie 9< cu!ture 'nd po!ymer'se ch'in re'ction o*

CS- 're *'ctors 'ssoci'ted %ith poor prognosis D3BE.

Seri'! C9 sc'n 't three 'nd six months is 'norm'! in

most 9< meningitis p'tients D42E. t six months, hydro8

ceph'!us, tuercu!om's 'nd exud'tes %i!! dis'ppe'r ut

ch'nges o* stroe rem'in the s'me D42E.

third o* p'tients %ith 9< meningitis m'y deterior'te

%ithin six %ees o* initi'tion o* tre'tment D42E. ;orsen8

ing on tre'tment is re!'ted to motor %e'ness 'nd >CS

on 'dmission D42E. ge !ess th'n one ye'r o!d 'nd

presence o* seere 9< 're ris *'ctors *or *'i!ure o*

'ntituercu8 !ous ther'py D44E.

3+ 'onclusions

9he di'gnosis o* 9< meningitis is di**icu!t ec'use o*

nonspeci*ic present'tion 'nd c!inic'! *e'tures. >ood

prognosis depends on prompt di'gnosis $e*ore *urther

neuro!ogic'! deterior'tion( %ith tre'tment5 there*ore r'8

dio!ogic'! *indings 're ery import'nt. recent study h's

sho%n th't high dose intr'enous ri*'mpicin $B00 mg

d'i!y( is 'ssoci'ted %ith reduced mort'!ity in p'tients

%ith 'd'nced dise'se.

n'!ysis o* iom'rers in 9< meningitis is import'nt.

9here is 'n incre'se in the !ee!s o* serum 'nd CS- 9?-8

U 'nd @-?8γ in 9< meningitis p'tients. @86 !ee! is '!so

incre'sed in p'tients %ith tuercu!om' 'nd exud'tes.

9here is '!so ' rise in the !ee!s o* @8B, @-?8'!ph',

@-?8g'mm', @810, CS- m'trix met'!!oprotein'ses, CS-

tissue inhiitors o* m'trix +et'!!oprotein'ses, >-

!ee!, c'sp'se81 'nd @81 β . Sign'!8regu!'tory protein

'!ph' is oerexpressed 't mR? !ee!.

9here is 'd'ncement o* rese'rch *or 9< meningitis.

9he 9< meningitis rese'rch is r'pid!y progressing. @n*uture, %e %i!! e '!e to see the dee!opment %ith re8

spect to tre'tment 'nd m'n'gement o* dise'se. 9hrough

the no%!edge o* iom'rers, etter 'nd more 'd'nced

'ntituercu!ous ther'py c'n e dee!oped.

RFR'%

D1E R. >'!imi, xtr'pu!mon'ry 9uercu!osis: 9uercu!ous

+eningitis ?e% )ee!opments,Q European Review for

Medical and Pharmacological ciences, o!. 17, ?o. 4,2011, pp. 36783B6.

D2E R. de!m'!e, -. 'noun,


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1069uercu!ous +eningitis: )i'gnostic 'nd R'dio!ogic'! -e'tures, P'thogenesis 'nd upt' 'nd #. S. 9y'gi, **i8

cient )i'gnosis o* 9uercu!ous +eningitis y )etectiono* +yco'cterium 9uercu!osis )? in Cererospin'!

-!uid -i!tr'tes sing PCR,Q "ournal of Medical Microbi-

ology, o!. 7B, Pt. 7, 200, pp. 6168624.

doi:10.10 /&mm.0.00601780

D16E . ='nn'n, . ='*eeH, S. Ch'ud'ry 'nd +. R'shid,

R'pid Con*irm'tion o* 9uercu!ous +eningitis in Chi!8

dren y iKuid Cu!ture +edi',Q "ournal of 'yub Medical

+ollege, 'bbottabad , Pa,istan, o!. 22, ?o. 4, 2010, pp.

1G181G7.

D1GE P. >'rcY', . . . 'mmie, R. =. =e%!ett, #. -. Schoem'n 'nd P. R.

)on'!d, 9uercu!ous Cerero'scu!'r )ise'se: Re8ie%,Q "ournal of !nfection, o!. 7, ?o. 3, 200, pp.1768166. doi:10.1016/&.&in*.200 .0G.012

D22E ). . )'stur, 9he P'tho!ogy 'nd P'thogenesis o* 9u8

ercu!ous nceph'!op'thy 'nd R'dicu!omye!op'thy:

Comp'rison %ith !!ergic nceph'!omye!itis,Q +hild O s

(ervous ystem, o!. 2, ?o. 1, 1B6, pp. 1381.

doi:10.100 G /. Chi' 'nd ;. C. Shen, oc'tions o*Cerer'! @n*'rctions in 9uercu!ousmeningitis,Q (euro-radiology, o!. 34, ?o. 3, 12, pp. 1G81.doi:10.100 G /


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Sh'rm', P. um'r, S. R'&'gop'!'n, . ;'dde!!, J. .


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9uercu!ous +eningitis: )i'gnostic 'nd R'dio!ogic'! -e'tures, P'thogenesis 'nd ro%th -'ctor in 9uercu!ous +eningi8

tis,Q !nternational "ournal of (euroscience, o!. 123, ?o.2, 2013, pp. 12B8132.

D34E >. . +'rx 'nd . ). Ch'n, 9uercu!ous +eningitis:

)i'gnosis 'nd 9re'tment "erie%,Q )uberculosis Re-

search and )reatment , o!. 2011, 2011, rtic!e @):

GBG64.

D37E >. 9h%'ites, +. -isher, C. =eming%'y, >. Scott, 9. So8!omon 'nd #. @nnes, uide!ines

*or the )i'gnosis 'nd 9re'tment o* 9uercu!osis o* the

Centr'! ?erous System in du!ts 'nd Chi!drenQ.

%%%.e!seierhe '!t h .com/&ourn'!s/&in*

D36E R. Rus!'mi, . R. >'niem, S. )i'n, . pri'ni, 9. =.chm'd, . #. 'n der en, >.

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Jurnal Meningitis TB 1