Tuberculoma in the Fourth Ventricle: An Unusual Location.

To present a young immunocompetent patient with a fourth ventricle tuberculoma without pulmonary tuberculosis. A previously healthy young male patient presented with a history of headache, nausea, and blurred vision. Neuroimaging revealed a mass present in the fourth ventricle. The lesion was successfully resected. Histological and microbiological findings suggested the presence of a tuberculoma. Tuberculomas can be found in the posterior fossa in adults. This infectious pathology should not be forsaken when considering the differential diagnosis for infratentorial masses.

Cognitive impairment in patients with central nervous system tuberculosis.

INTRODUCTION: Tuberculosis (TB) in Mexico remains an important cause of morbidity and mortality; in the past 4 years, 110,681 cases of pulmonary tuberculosis and 1571 cases of tuberculous meningitis were reported. OBJECTIVE: To determine the neurocognitive sequelae, clinical presentation and neuroimaging alterations in patients with central nervous system tuberculosis. METHODS: A retrospective, analytical, and cross-sectional study was carried out from 2010 to 2019. Patients with central nervous system tuberculosis, with and without HIV/AIDS coinfection, were included. RESULTS: During the study period, 104 cases with a definitive or probable central nervous system tuberculosis diagnosis were included; 38% had HIV/AIDS coinfection, and 55%, various comorbidities (p = 0.0001); 49% had cognitive alterations, and 14% died. CONCLUSIONS: Although HIV/AIDS infection can contribute to cognitive decline in patients with tuberculous meningitis, no differences were observed between patients with and without HIV/AIDS. Cognitive sequelae showed improvement during follow-up with adequate management and therapeutic control of the patients.

INTRODUCCIÓN: La tuberculosis en México sigue siendo causa importante de morbimortalidad; en los últimos cuatro años, se reportaron 110 681 casos de tuberculosis pulmonar y 1571 casos de tuberculosis meníngea. OBJETIVO: Determinar las secuelas neurocognoscitivas, presentación clínica y alteraciones en los estudios de neuroimagen en pacientes con tuberculosis del sistema nervioso central. MÉTODOS: Se realizó un estudio retrospectivo, analítico y transversal de 2010 a 2019. Se incluyeron pacientes con tuberculosis del sistema nervioso central, con y sin coinfección por VIH/sida. RESULTADOS: Durante el periodo de estudio se incluyeron 104 casos con diagnóstico definitivo y probable de tuberculosis del sistema nervioso central; de acuerdo con los criterios de Marais, 38 % presentó coinfección por VIH/sida y 55 %, diversas comorbilidades (p = 0.0001); 49 % presentó alteraciones cognoscitivas y 14 % falleció. CONCLUSIONES: Aunque la infección por VIH/sida puede contribuir al deterioro cognitivo del paciente con tuberculosis meníngea, no se observaron diferencias entre pacientes con y sin VIH/sida. Las secuelas cognoscitivas mostraron mejoría en el seguimiento con el adecuado manejo y control terapéutico de los pacientes.

Ischemic Stroke and Disseminated Tuberculosis in Intensive Care: A Case Report.

BACKGROUND Tuberculosis (TB) continues to be a major public health problem worldwide. Extrapulmonary tuberculosis at the level of the central nervous system is the most devastating and deadly form of tuberculosis. CASE REPORT We present the case of a 73-year-old male Ecuadorian patient with no history of contact with tuberculosis and with a clinical picture of 4 days of evolution characterized by aphasia, deviation of the labial commissure, and deterioration of the level of consciousness with a Glasgow coma score of 7/15. A brain tomography showed evidence of indirect signs of cerebral ischemia; the patient was therefore diagnosed with non-specific cerebrovascular disease. Due to the critical nature of his clinical picture, the patient entered the Intensive Care Unit (ICU), where a chest x-ray was performed and bilateral perihilar alveolar opacities with a reticular and nodular pattern were visualized. These results, combined with the bronchoalveolar brushing, evidenced the presence of Mycobacterium tuberculosis. Adenosine of deaminase (ADA) was also detected in the cerebrospinal fluid with 30.7 µ/L and a molecular biology technique was used with high-multiplex real-time polymerase matrix MALDI-TOF mass spectrometry (Brucker Daltonics) for rapid identification of the causative agent. DNA/polymerase chain reaction (PCR) analyses were used for detection of M. tuberculosis, subsequently confirming the presence of cerebral tuberculosis. CONCLUSIONS This case illustrated an infrequent form of disseminated tuberculosis in a critically ill patient. Timely diagnosis and appropriate management are essential to reducing mortality.

Brain Tuberculoma as a Differential Diagnosis of Single Intracranial Lesion: Case Report

Tuberculosis (TB) of the central nervous system (CNS) is considered one of the most severe forms of presentation of the disease. Although only 1% of TB cases involve the CNS, these cases represent around between 5 and 15% of extrapulmonary forms.1,2 Tuberculous meningitis (TBM) is the most frequent form of CNS TB. The granulomas formed in the cerebral tuberculoma may cause hydrocephalus and other symptoms indicative of a CNS mass lesion. In the absence of active TB or TBM, the symptoms may be interpreted as indicative of tumors.3,4 The prognosis is directly related to the early diagnosis and proper treatment installation.5 We report the case of a patient with intracranial hypertension syndrome, expansive mass in the parieto-occipital region, accompanied by a lesion in the rib, initially thought to be a metastatic lesion, although posteriorly diagnosed as a cerebral tuberculoma.

Características epidemiológicas y clínicas de pacientes con tuberculosis. Experiencia Hospital Nacional / Epidemiological and clinical characteristics of patients with tuberculosis. Hospital Nacional Experience

Introducción. La tuberculosis (TB) continúa siendo un grave problema de salud pública a nivel mundial. En el Paraguay, no se ha logrado controlar esta infección. La epidemia de VIH/SIDA ha aumentado la carga de esta enfermedad. Objetivo. Determinar las características clínico-epidemiológicas de pacientes adultos con diagnóstico de TB internados en el Hospital Nacional de Itauguá entre enero 2008- marzo 2018. Metodología. Estudio retrospectivo descriptivo de corte transversal, de casos consecutivos en pacientes adultos con diagnóstico de TB internados en el Hospital Nacional de Itauguá entre enero 2008-marzo 2018. Resultados. Se incluyeron 72 pacientes entre 18 y 86 años (edad media: 41 ± 17,9 años); varones (61,1%), y 59,7% del Departamento Central, desempleados (15,8%), profesionales de salud (4,2%). El 87,5% presentaba alguna comorbilidad, infección con VIH (55,5%); Lupus Eritematoso Sistémico (6,3%), Diabetes mellitus Tipo 2 (6,3%), desnutrición (15,8%), etilista (9,5%), tabaquistas, consumo de corticoides (14,2%); fiebre prolongada (63,8%), fiebre aguda (36,2%), tuberculosis pulmonar (50%), miliar (11,1%) y de las extrapulmonares: pleural (9,7%), meníngea (8,3%), Sistema Nervioso Central (tuberculoma) 9,7%, digestiva (8,3%), ganglionar (6,9%), columna vertebral (2,7%), cutánea (2,7%), urogenital (1,3%). Tuberculosis asociada: miliar-cutánea (10%), pulmonar-ganglionar (10%), pulmonar-digestiva (20%), pulmonar-pleural (10%), pulmonar-tuberculoma (40%). La tuberculosis fue reveladora de la infección HIV en el 15,1%, la mortalidad fue de 6,9%. Hubo asociación entre la tuberculosis miliar y mortalidad. Conclusión. La mayoría de los pacientes eran adultos jóvenes, la infección por HIV fue la comorbilidad principal. La forma pulmonar y extra pulmonar se presentó en igual proporción.

Introduction. Tuberculosis (TB) continues to be a serious public health problem worldwide. In Paraguay, this infection has not been controlled. The HIV/AIDS epidemic has increased the burden of this disease. Objective. To determine the clinical-epidemiological characteristics of adult patients diagnosed with hospitalized TB at the Hospital Nacional de Itaugua between January 2008- March 2018. Methodology. Retrospective, descriptive cross-sectional study of consecutive cases in adult patients with the diagnosis of tuberculosis hospitalized at the Hospital Nacional de Itauguá from January 2008 to March 2018. Results: A total of 72 patients between 18 and 86 years (mean age: 41 ± 17.9 years) were included; 61.1% men, 59.7% from the Central Department, 15.8% unemployed, health professionals (4.2%). 87.5% had a comorbidity, HIV infection (55.5%), Systemic Lupus Erythematosus (6.3%), Type 2 Diabetes mellitus (6.3%), malnutrition (15.8%), ethylic (9.5%), smoking, corticosteroid consumption (14.2%); prolonged fever (63.8%), acute fever (36.2%), pulmonary tuberculosis (50%), miliary (11.1%) and extrapulmonary tuberculosis: pleural (9.7%), meningeal (8.3 %), Central Nervous System (tuberculoma) 9.7%, digestive (8.3%), lymph node (6.9%), spine (2.7%), cutaneous (2.7%), urogenital (1,3%). Associated tuberculosis: miliarycutaneous (10%), pulmonary-lymph node (10%), pulmonary-digestive (20%), pulmonary-pleural (10%), pulmonary-tuberculoma (40%). Tuberculosis was revealing of HIV infection in 15.1%, mortality was 6.9%. There was an association between miliary tuberculosis and mortality. Conclusions. The majority of the patients were young adults, HIV infection was the main comorbidity. The pulmonary and extra pulmonary form was presented in equal proportion.

Extrapulmonary Tuberculosis: Pathophysiology and Imaging Findings.

Extrapulmonary tuberculosis (TB) represents approximately 15% of all TB infections. It is difficult to diagnose on the basis of imaging characteristics and clinical symptoms, and biopsy is required in many cases. Radiologists must be aware of the imaging findings of extrapulmonary TB to identify the condition in high-risk patients, even in the absence of active pulmonary infection. In extrapulmonary TB, the lymphatic system is most frequently affected. The presence of necrotic lymph nodes and other organ-specific imaging features increases the diagnostic probability of extrapulmonary TB. Disseminated infection and central nervous system involvement are the most frequent manifestations in immunosuppressed patients. Renal disease can occur in immunocompetent patients with very long latency periods between the primary pulmonary infection and genitourinary involvement. In several cases, gastrointestinal, solid-organ, and peritoneal TB show nonspecific imaging findings. Tuberculous spondylitis is the most frequent musculoskeletal manifestation. It is usually diagnosed late and affects multiple vertebral segments with extensive paraspinal abscess. Articular disease is the second most frequent musculoskeletal manifestation, and synovitis is its predominant imaging finding.©RSNA, 2019.

Tuberculoma intracerebral en gestante inmunocompetente / Intracerebral tuberculosis in pregnant immunocompetent

La tuberculosis causada por la bacteria Mycobacterium tuberculosis, se encuentra entre las 10 primeras causas de mortalidad a nivel mundial; la presentación extrapulmonar se produce por siembra vía hematógena o linfática desde un foco primario, correspondiendo a la afectación de sistema nervioso central el 5% de infecciones por TB y se presenta con menor frecuencia en personas inmunocompetentes. Las formas de tuberculosis de SNC son meningitis, tuberculosis espinal y tuberculomas que corresponden al 1% de infecciones por TB. El tratamiento se basa en la terapia antifímica, reservando el manejo neuroquirúrgico para puntuales indicaciones como deterioro neurológico, hidrocefalia o mala respuesta al tratamiento farmacológico.

Tuberculosis, caused by the Mycobacterium tuberculosis bacteria, is among the top 10 cau-ses of mortality worldwide; The extrapulmonary presentation is produced by hematogenous or lymphatic seeding from a primary focus, 5% of TB infections corresponding to central nervous system involvement and occurs less frequently in immunocompetent people. The forms of CNS tuberculosis are meningitis, spinal tuberculosis and tuberculomas that corres- pond to 1% of TB infections. The treatment is based on antifungal therapy, reserving neurosurgical management for specific indications such as neurodeterioration, hydrocephalus or poor response to pharmacological treatment

Tuberculosis of the central nervous system in cattle in Paraíba, Brazil / Tuberculose no sistema nervoso central de bovinos na Paraíba

This paper describes six cases of tuberculosis in the central nervous system (CNS) of cattle in the state of Paraíba in northeastern Brazil. We reviewed the autopsy reports of 851 bovine necropsies performed from 2003 to 2016. Seventy-three (8.6%) cattle were diagnosed with tuberculosis and six showed lesions in the CNS. Three cases affected cattle up to two-year-old and other three affected adults. Three cattle presented exclusively nervous signs, two had respiratory signs and weight loss and one did not present any clinical signs. At necropsy, five cattle had thickening of the leptomeninges of the cerebellum, pons, obex, spinal cord and cortex, mainly, in the region near the brain basilar Willis´ circle. Another animal, presented a single focal lesion in the cerebellum. Microscopically we observed moderate to severe granulomatous meningitis and encephalitis. Five cattle presented lesions in the lungs and mediastinal lymph nodes and three of them had disseminated lesions in other organs. In all cattle acid-fast bacilli were observed in the lesions and marked positive for immunohistochemistry with polyclonal antibody anti-Mycobacterium tuberculosis. It is concluded that bovine tuberculosis of central nervous system occurs sporadically in Paraíba, in cattle of different ages, most of them with disseminate lesions in other organs. The location of the lesions suggests that the agent invaded the brain by hematogenous route through the circle of Willis.(AU)

Descrevem-se seis casos de tuberculose no sistema nervoso central (SNC) em bovinos, no semiárido da Paraíba. Foram revisados os laudos de um total de 851 necropsias de bovinos realizadas no período de 2003 a 2016. Destes, 73 (8,6%) foram diagnosticados com tuberculose e seis apresentavam lesões no SNC. Três casos ocorreram em bovinos de até dois anos de idade e três em bovinos adultos. Três bovinos apresentaram exclusivamente sinais nervosos, dois tinham sinais respiratórios e perda de peso e um não apresentava nenhum sinal clínico. Macroscopicamente, em cinco bovinos, havia espessamento das leptomeninges do cerebelo, medula espinhal, ponte, obex, colículos e córtex, principalmente, na região basilar encefálica próxima ao polígono de Willis. Em apenas um bovino houve a presença de tubérculo único no cerebelo. Microscopicamente observou-se moderada a acentuada meningite e encefalite granulomatosa. Cinco bovinos apresentaram lesões pulmonares e nos gânglios mediastínicos e três deles tinham lesões disseminadas em outros órgãos. Em todos os bovinos foram encontrados bacilos ácido-álcool resistentes intralesionais e todos tiveram marcação positiva na técnica de imuno-histoquímica com anticorpo policlonal anti-Mycobacterium tuberculosis. Conclui-se que a tuberculose do sistema nervoso central de bovinos ocorre de forma esporádica na Paraíba, principalmente em bovinos com lesões disseminadas em outros órgãos. Sugere-se que a disseminação do agente ocorre pela via hematógena, possivelmente através do polígono de Willis.(AU)

Tuberculosis of the central nervous system in cattle in Paraíba, Brazil / Tuberculose no sistema nervoso central de bovinos na Paraíba

This paper describes six cases of tuberculosis in the central nervous system (CNS) of cattle in the state of Paraíba in northeastern Brazil. We reviewed the autopsy reports of 851 bovine necropsies performed from 2003 to 2016. Seventy-three (8.6%) cattle were diagnosed with tuberculosis and six showed lesions in the CNS. Three cases affected cattle up to two-year-old and other three affected adults. Three cattle presented exclusively nervous signs, two had respiratory signs and weight loss and one did not present any clinical signs. At necropsy, five cattle had thickening of the leptomeninges of the cerebellum, pons, obex, spinal cord and cortex, mainly, in the region near the brain basilar Willis´ circle. Another animal, presented a single focal lesion in the cerebellum. Microscopically we observed moderate to severe granulomatous meningitis and encephalitis. Five cattle presented lesions in the lungs and mediastinal lymph nodes and three of them had disseminated lesions in other organs. In all cattle acid-fast bacilli were observed in the lesions and marked positive for immunohistochemistry with polyclonal antibody anti-Mycobacterium tuberculosis. It is concluded that bovine tuberculosis of central nervous system occurs sporadically in Paraíba, in cattle of different ages, most of them with disseminate lesions in other organs. The location of the lesions suggests that the agent invaded the brain by hematogenous route through the circle of Willis.(AU)

Descrevem-se seis casos de tuberculose no sistema nervoso central (SNC) em bovinos, no semiárido da Paraíba. Foram revisados os laudos de um total de 851 necropsias de bovinos realizadas no período de 2003 a 2016. Destes, 73 (8,6%) foram diagnosticados com tuberculose e seis apresentavam lesões no SNC. Três casos ocorreram em bovinos de até dois anos de idade e três em bovinos adultos. Três bovinos apresentaram exclusivamente sinais nervosos, dois tinham sinais respiratórios e perda de peso e um não apresentava nenhum sinal clínico. Macroscopicamente, em cinco bovinos, havia espessamento das leptomeninges do cerebelo, medula espinhal, ponte, obex, colículos e córtex, principalmente, na região basilar encefálica próxima ao polígono de Willis. Em apenas um bovino houve a presença de tubérculo único no cerebelo. Microscopicamente observou-se moderada a acentuada meningite e encefalite granulomatosa. Cinco bovinos apresentaram lesões pulmonares e nos gânglios mediastínicos e três deles tinham lesões disseminadas em outros órgãos. Em todos os bovinos foram encontrados bacilos ácido-álcool resistentes intralesionais e todos tiveram marcação positiva na técnica de imuno-histoquímica com anticorpo policlonal anti-Mycobacterium tuberculosis. Conclui-se que a tuberculose do sistema nervoso central de bovinos ocorre de forma esporádica na Paraíba, principalmente em bovinos com lesões disseminadas em outros órgãos. Sugere-se que a disseminação do agente ocorre pela via hematógena, possivelmente através do polígono de Willis.(AU)

O complexo diagnóstico da meningoencefalite tuberculosa e a sua influência sobre o prognóstico: relato de um caso pediátrico e busca sistematizada da literatura / The diagnostic complex of tuberculous meningoencephalitis and its influence on the prognosis: report of a pediatric case and systematized search of the literature

Contexto: A meningoencefalite tuberculosa (MTB) é uma complicação de alta morbimortalidade, rara e temida da tuberculose primária em crianças, acometendo principalmente os lactentes e adolescentes. Diferentemente do que ocorre no acometimento no adulto, os casos pediátricos são, na maioria, diagnosticados quando estão em estágios avançados, o que é justificado pela baixa especificidade clínica e laboratorial da investigação na população desta faixa etária. Descrição do caso: Lactente masculino de sete meses de idade chegou ao serviço de referência de seu município com quadro arrastado de tosse, febre intermitente e dificuldade respiratória e, após exames laboratoriais e de imagem sugestivos de broncopneumonia, chegou-se ao diagnóstico clínico de tuberculose miliar com MTB. Durante a internação, já com tratamento instituído e recomendado pelo Ministério da Saúde e pela Organização Mundial de Saúde, o paciente evoluiu com comprometimento neurológico focal, apresentando melhora dos sinais após quatro dias de internação. Após alta, o paciente foi reavaliado, apresentando melhora clínica significativa. Discussão: A disponibilidade de métodos com alta especificidade e sensibilidade para o diagnóstico da tuberculose no lactente ainda é baixa, dificultando, assim, a prevenção de complicações em populações oligossintomáticas e com apresentação inespecífica. Observou-se, nesse caso, que, mesmo após o diagnóstico e a implementação do tratamento preconizado para MTB, o paciente evoluiu com discreta sequela neurológica (paresia de membro inferior esquerdo). Conclusão: Este estudo evidenciou a relevância do diagnóstico precoce e da implementação do tratamento adequado para evitar sequelas neurológicas que podem ser irreversíveis, determinando evolução clínica favorável.

Experimental animal models of central nervous system tuberculosis: A historical review.

Animal models are and will remain valuable tools in medical research because their use enables a deeper understanding of disease development, thus generating important knowledge for developing disease control strategies. Central nervous system tuberculosis (CNS TB) is the most devastating disease in humans. Moreover, as the variability of signs and symptoms delay a timely diagnosis, patients usually arrive at the hospital suffering from late stage disease. Therefore, it is impossible to obtain fresh human tissue for research before an autopsy. Because of these reasons, studies on human CNS TB are limited to case series, pharmacological response reports, and post mortem histopathological studies. Here, we review the contribution of the different animal models to understand the immunopathology of the disease and the host-parasitic relationship, as well as in the development of new strategies of vaccination and to test new drugs for the treatment of CNS TB.

[Not Available]. / Meningoencefalitis tuberculosa con quistes aracnoideos medulares y siringomielia aguda.

TITLE: Meningoencefalitis tuberculosa con quistes aracnoideos medulares y siringomielia aguda.

Características diagnósticas de tuberculosis intracraneal en hospitalizados del Servicio de Neurología del Hospital Nacional Guillermo Almenara Irigoyen 2008 - 2012 / Diagnostic features of the intracranial tuberculosis in hospitalized in the Neurology Service at the National Hospital Guillermo Almenara Irigoyen 2008 - 2012

Objetivos: Describir las características diagnosticas epidemiológicas, clínicas, de LCR, imagenológicas de tuberculosis intracraneal (TBC Meníngea, Tuberculoma) en hospitalizados del Servicio de Neurología del Hospital Nacional Guillermo Almenara Irigoyen 2008-2012. Materiales y Métodos: Se seleccionó la historia de todos los pacientes hospitalizados en el Servicio de Neurología del Hospital Nacional Guillermo Almenara Irigoyen entre los años 2008 y 2012 con diagnóstico de tuberculosis intracraneal confirmada o sospechosa con un número total de 26 casos. Se obtuvo datos de filiación, antecedentes epidemiológicos, historia de enfermedad, examen neurológico de los 26 pacientes; estudios en LCR: bioquímicos y citoquímicos en 25 pacientes, bk en 20 pacientes, ADA en 20 pacientes, PCR en 8 pacientes y cultivo en 7 pacientes; a los 26 casos se realizó TAC de encéfalo, y a 17 RMN de encéfalo. Resultados: En el Servicio de Neurología del Hospital Nacional Guillermo Almenara referente de la red Almenara se hospitalizaron 26 casos de Tuberculosis Intracraneal (1.47 por ciento de hospitalizados en el Servicio de Neurología) del año 2008 al 2012, de los cuales 19 casos (73.07 por ciento) fueron Tuberculoma cerebral y 07 casos (26.93 por ciento) Meningoencefalitis Tuberculosa (MEC TBC); 17 casos (65.381 por ciento) fueron de sexo masculino y 9 (35.62 por ciento) de sexo femenino, la mayoría estuvieron comprendidos entre el segmento 26 a 40 años con 14 (54.85 por ciento) casos siendo predominante tanto para tuberculoma cerebral 11 (57.89 por ciento), como para MEC TBC 03 (42.86 por ciento); la mayoría provinieron de la Red Almenara 20 (76.91 por ciento) a diferencia de otros 6 casos (23.08 por ciento) que provinieron de otras redes; el tipo de seguro en su mayoría fue obligatorio (principal aportante activo del seguro social) con 15 (57.68 por ciento) pacientes. De los antecedentes epidemiológicos 08 pacientes (30.77 por ciento) tuvieron contacto familiar de tuberculosis...

Objectives: Describe diagnostic epidemiological, clinical, CSF, imaging of intracranial tuberculosis (TBC Meningeal, Tuberculoma) in hospitalized Neurology Service of the National Hospital Guillermo Almenara Irigoyen 2008-2012. Materials and methods: The history of all patients hospitalized in the Neurology Service of Guillermo Almenara Irigoyen National Hospital between 2008 and 2012 confirmed or suspected diagnosis of a total number of 26 cases intracranial tuberculosis was selected. Personal data, epidemiological history, history of disease, neurological examination of 26 patients was obtained; CSF studies: Biochemical and cytochemical in 25 patients, 20 patients bk, ADA in 20 patients, 8 patients PCR and culture in 7 patients; the 26 cases of brain CT scan was performed, and 17 NMR brain. Results: In the Neurology Service of the Guillermo Almenara National Hospital, Almenara benchmark of 26 cases of Tuberculosis Intracranial (1.47 per cent of hospitalized in the Neurology Service) they were hospitalized 2008 to 2012, of which 19 cases (73.07 per cent) were Tuberculoma cerebral and 07 cases (26.93 per cent) meningoencephalitis Tuberculous (TBC MEC); 17 cases (65.381 per cent) were males and 9 (35.62 per cent) were female, most were between the segment 26 to 40 years with 14 (54.85 per cent) cases being predominant both cerebral tuberculoma 11 (57.89 per cent) and for MEC TBC 03 (42.86 per cent); most carne from Beacon Red 20 (76.91 per cent) unlike another 6 cases (23.08 per cent) that carne from other networks; the type of insurance was mostly compulsory (primary active contributor of social insurance) 15 (57.68 per cent) patients. The epidemiological history of 08 patients (30.77 per cent) had household contact with tuberculosis; 03 (11.54 per cent) patients had associated immune suppression, with only 3 cases of TBC MEC (MEC 42.86 per cent). The most common general symptoms were headache in 20 cases (76.92 per cent), followed by nausea and vomiting in...

Reacción paradojal en meningitis tuberculosa: presentación de un caso / Paradoxical reaction in tuberculous meningitis: a case report

La afectación del sistema nervioso central es una de las localizaciones extrapulmonares de la tuberculosis con peor pronóstico. El retraso en el diagnóstico y tratamiento es uno de los factores relacionados con mayor tasa de mortalidad y secuelas. Se describe la "reacción paradojal" como un deterioro sintomático de grado variable, durante el tratamiento efectivo de la tuberculosis. El aumento de la resistencia del Mycobacterium tuberculosis a fármacos observado en los últimos años genera mayor preocupación ante la aparición de una reacción paradojal durante el tratamiento. Se presenta el caso de un niño con meningitis tuberculosa que, luego de un mes de tratamiento, presentó empeoramiento clínico y nuevas lesiones en la tomografía y resonancia magnética nuclear de cerebro. Se excluyeron patologías asociadas, se verificó que la toma de medicamentos haya sido supervisada, y la sensibilidad del bacilo a fármacos antituberculosos de primera línea fue confirmada. El paciente no requirió cambios en el esquema de tratamiento antituberculoso y se administraron esteroides para el alivio sintomático. La reacción paradojal durante el tratamiento antituberculoso es infrecuente y debida a una reacción de hipersensibilidad entre el huésped y el bacilo tuberculoso. Cuando aparece, se debe asegurar la efectividad y el cumplimiento del tratamiento administrado.

The central nervous system is one of the locations of extrapulmonary tuberculosis with worse prognosis. The delay in diagnosis and treatment is one of the factors associated with higher mortality and sequelae. The "paradoxical reaction" is described as a variable degree of symptomatic deterioration during the effective treatment of tuberculosis. The increased resistance of Mycobacterium tuberculosis to drugs observed in recent years generates greater concern about the emergence of a paradoxical reaction during treatment. The case of a child with tuberculous meningitis that after one month of treatment presented clinical worsening and new lesions in CT and MRI images of the brain is presented. Comorbidities were excluded, it was verified that taking drugs has been monitored, and the sensitivity of the bacillus to first-line antituberculosis drugs was confirmed. The patient required no change in the pattern of tuberculosis treatment and steroids were administered for symptomatic relief. The paradoxical reaction during antituberculosis treatment is rare and due to a hypersensitivity reaction between the host and the tuberculous bacillus. When it appears you must ensure the effectiveness and compliance of the treatment.

Modulation of angiogenic factor VEGF by DNA-hsp65 vaccination in a murine CNS tuberculosis model.

Tuberculosis (TB) is a serious public health problem. Development of experimental models and vaccines are essential to elucidate physiopathological mechanisms and to control the disease. Vascular endothelial growth factor (VEGF) is a potent activator of vascular permeability and angiogenesis. VEGF seems to participate in breakdown of the blood brain-barrier (BBB) in tuberculous meningitis (TBM), contributing to worsening of disease. Therefore, the objective here was to extent the characterization of our previously described murine model of central nervous system TB (CNS-TB) by describing the VEGF participation in the CNS disease, and suggesting a vaccination plan in mice. Plasmid encoding DNA protein antigen DNA-hsp65 has been described as a protector against TB infection and was used here to test its effectiveness in the prevention of VEGF production and TB disease. Vaccinated mice and its controls were injected with Mycobacterium bovis bacillus Calmette-Guerin (BCG) in cerebellum. Four weeks after BCG injection, mice were perfused and brains were paraffin-embedded for VEGF expression analysis. We observed VEGF immunohistochemical expression in TBM and granulomas in non-vaccinated mice. The DNA-hsp65 treatment blocked the expression of VEGF in mice TBM. Therefore, our murine model indicated the VEGF participation in the physiopathology of CNS-TB and the potential prevention of the DNA-hsp65 in the disease progression.