Acute Presentation of Central Nervous System Tuberculosis: A Retrospective Study and Review of Literature
Authors/Creators
- 1. Assistant Professor; Department of Medicine Government Medical College Srinagar
- 2. Lecturer, Department of Medicine Government Medical College Srinagar
- 3. Registrar, Department of Medicine Government Medical College Srinagar
Description
Tubercular meningitis has been classically described as sub-acute or chronic meningitis that evolves over a course of weeks to months. However in some cases the onset is acute or sometimes abrupt with features of encephalitis. In a review of adult patients of tubercular meningitis, 10 cases were found to have an acute presentation with features of encephalitis. Acute presentation was defined as symptom duration of 07 days or less. The international encephalitis consortium criteria were used for case definition of encephalitis. The patients varied in age between 14 to 35 years. Three patients had definite tubercular etiology while three were probable and four were possible tubercular encephalitis. Encephalopathy manifested in the form of worsening of sensorium in 06 patients, irritability in 02 and behavioral disturbance in 02 patients. The average duration of symptoms before presentation was 5.2 days. Signs of meningeal irritation were present in 09 patients. On CSF analysis, all patients showed pleocytosis with elevated CSF protein, while glucose was low in 08 patients. The average time delay before commencement of anti-tubercular treatment was 11.6 days. Nine patients improved while one died during hospital stay. Acute encephalitic presentation of central nervous system tuberculosis is an under recognized entity that requires a high index of suspicion. Early recognition of this entity can be life- saving and prevent serious complications.
Abstract (English)
Tubercular meningitis has been classically described as sub-acute or chronic meningitis that evolves over a course of weeks to months. However in some cases the onset is acute or sometimes abrupt with features of encephalitis. In a review of adult patients of tubercular meningitis, 10 cases were found to have an acute presentation with features of encephalitis. Acute presentation was defined as symptom duration of 07 days or less. The international encephalitis consortium criteria were used for case definition of encephalitis. The patients varied in age between 14 to 35 years. Three patients had definite tubercular etiology while three were probable and four were possible tubercular encephalitis. Encephalopathy manifested in the form of worsening of sensorium in 06 patients, irritability in 02 and behavioral disturbance in 02 patients. The average duration of symptoms before presentation was 5.2 days. Signs of meningeal irritation were present in 09 patients. On CSF analysis, all patients showed pleocytosis with elevated CSF protein, while glucose was low in 08 patients. The average time delay before commencement of anti-tubercular treatment was 11.6 days. Nine patients improved while one died during hospital stay. Acute encephalitic presentation of central nervous system tuberculosis is an under recognized entity that requires a high index of suspicion. Early recognition of this entity can be life- saving and prevent serious complications.
Files
IJPCR,Vol15,Issue9,Article197.pdf
Files
(338.8 kB)
| Name | Size | Download all |
|---|---|---|
|
md5:9c4a1a32d9069693a81e12ccda69f1e0
|
338.8 kB | Preview Download |
Additional details
Dates
- Accepted
-
2023-08-30
Software
- Repository URL
- https://impactfactor.org/PDF/IJPCR/15/IJPCR,Vol15,Issue9,Article197.pdf
- Development Status
- Active
References
- 1. Granerod J, Ambrose HE, Davies NW, Clewley JP, Walsh AL, Morgan D et al. Causes of encephalitis and differences in their clinical presentations in England: a multicentre, population-based prospective study. Lancet Infect Dis 2010; 10: 835–44. 2. Lee TC, Tsai CP, Yuan CL, Wei CY, Tsao WL, Lee RJ. Encephalitis in Taiwan: A Prospective Hospital-Based Study. Jpn. J. Infect. Dis. 2003; 56: 193-199. 3. Sonneville R, Gault N, Montmollin E, Klein IF, Mariotte E, Chemam S. Clinical spectrum and outcomes of patients with encephalitis requiring intensive care. European Journal of Neurology 2015; 22:6–16 4. Mailles A, Vaillant V, Stahl JP. Infectious encephalitis in France from 2000 to 2002: the hospital database is a valuable but limited source of information for epidemiological studies [in French]. Med Mal Infect 2007; 37:95–102. 5. Christie LJ, Loeffler AM, Honarmand S, Flood JM, Baxter R, Jacobson S, et al. Diagnostic Challenges of Central Nervous System Tuberculosis. Emerg Infect Dis. 2008;14(9):1473-1475. 6. Taylor KB, Smith HV, Vollum RL. Tubercular meningitis of acute onset. JNNP 1955; 18: 165. 7. Bloch KC, Glaser CA. Encephalitis Surveillance through the Emerging Infections Program, 1997-2010. Emerg Infect Dis. 2015 Sep; 21(9):1562-7. 8. Venkatesan A, Tunkel AR, Bloch KC, Lauring AS, Sejvar J, Bitnun A et al.Case definitions, diagnostic algorithms, and priorities in encephalitis. Consensus statement of the international encephalitis consortium. CLIN Infect Dis. 2013;57(8):1114-18. 9. Honnorat E, De Broucker T, Mailles A, Stahl JP. Encephalitis due to Mycobacterium tuberculosis in France. Médecine et Maladies Infectieuses 2013; 43(6): 230-238. 10. Marais S, Thwaites G, Schoeman JF, Török ME, Misra UK, Prasad K, et al. Tuberculous meningitis: a uniform case definition for use in clinical research. Lancet Infect Dis 2010 Nov; 10(11):803-812. 11. Wood M, Anderson M. Chronic meningitis. In: Neurological infections; major problems in Neurology, vol 16. Philadelphia: WB Saunders, 1998; p 169–248. 12. Stahl, J.P. (2019). Tuberculous Encephalitis. In: Sener, A., Erdem, H. (eds) Extrapulmonary Tuberculosis. Springer, Cham. https://doi.org/10.1007/978-3-030-04744-3_9. 13. Karmarkar SA, Aneja S, Khare S, Saini A, Seth A, Chauhan BK. A Study of Acute Febrile Encephalopathy with Special Reference to Viral Etiology. Indian J Pediatr 2008; 75 (8): 801-805. 14. Utigard E, Katyshev V, Isada C, Dani D. Acute onset and rapid progression of tubercular meningitis and ischemic infarcts in an immune competent patient. Neurology 2017; 88 (16): P1.317. 15. Maramattom BV, Santhamma SGN. Tuberculous Encephalitis May Be Undetectable on Magnetic Resonance Imaging but Detectable on 18F-Fluorodeoxyglucose Positron Emission Tomography–Computed Tomography. The American Journal of Tropical Medicine and Hygiene. 2021; 105(4):1031-1037. 16. Diaz-Arias, L.A., Pardo, C.A. &Probasco, J.C. Infectious Encephalitis in the Neurocritical Care Unit. Curr Treat Options Neurol 2020; 22: 18.