Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 51
Filtrar
Mais filtros










Base de dados
Tipo de estudo
Intervalo de ano de publicação
1.
Infect Dis (Lond) ; 51(5): 368-372, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30907215

RESUMO

BACKGROUND: Paediatric central nervous system (CNS) tuberculosis (TB) imposes a high risk of death and neurologic sequelae, particularly if the diagnosis is delayed. Children from non-TB endemic countries are particularly at risk of delayed or missed diagnosis. We aimed to investigate CNS TB in Denmark, a TB low-endemic country and where Bacillus Calmette-Guerin (BCG) vaccination is not a part of the vaccination schedule. METHODS: A nationwide retrospective case survey of all children with CNS TB in 2000-2015 identified through the National Danish TB Notification Register. We assessed epidemiology, clinical and paraclinical features, diagnostic criteria, treatment and outcome. RESULTS: Nine ethnic Danes and 12 children from TB-endemic countries with CNS TB were identified. Clinical features, C-reactive protein, chest X-ray and indirect TB screening assays all had low sensitivity (19-75%). All (18/18) patients had elevated cerebrospinal fluid (CSF) white blood cells and 15 of 17 (88%) had a combination of at least two characteristic CSF findings (lymphocyte predominance, elevated protein and/or hypoglycorrhachia). Cerebral computed tomography and magnetic resonance imaging were abnormal in 10 of 16 (63%) and 12 of 14 (86%), respectively. Treatment was initiated after a median of 3 days in children from TB-endemic countries, and after 10 days in ethnic Danish children. One patient died (5%): A native Danish girl who died before the diagnosis was established. CONCLUSIONS: Children from non-TB endemic countries may be at risk of delayed diagnosis and poorer prognosis compared to high-risk children. Cerebral magnetic resonance imaging and characteristic CSF findings had high diagnostic sensitivity.


Assuntos
Grupos Étnicos , Sistema de Registros , Tuberculose do Sistema Nervoso Central/epidemiologia , Adolescente , Antibacterianos/uso terapêutico , Vacina BCG , Criança , Pré-Escolar , Diagnóstico Tardio , Dinamarca/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Imagem por Ressonância Magnética , Masculino , Mycobacterium tuberculosis/patogenicidade , Estudos Retrospectivos , Fatores de Risco , Inquéritos e Questionários , Tuberculose do Sistema Nervoso Central/diagnóstico por imagem , Tuberculose do Sistema Nervoso Central/tratamento farmacológico , Vacinação/estatística & dados numéricos
2.
Indian J Tuberc ; 66(1): 49-57, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30797283

RESUMO

OBJECTIVES: Central nervous system (CNS) is an important site for extrapulmonary tuberculosis. The present study evaluated the spectrum of CNS tuberculosis in a high tuberculosis endemic region. METHODS: The study included 306 cases of CNS tuberculosis. All cases were assessed for clinical evaluation and neuroimaging. All cases were followed up for 3 months. Modified Barthel index was used to assess the outcome. RESULTS: Out of 306 cases of CNS tuberculosis, 174 (56.86%) had intracranial tuberculosis, 55 (17.97%) had spinal tuberculosis, 15 (4.91%) had both intracranial and spinal pathology. Sixty-two (20.26%) patients had disseminated tuberculosis. Two-hundred and fourteen (69.9%) cases had tuberculous meningitis. Disseminated tuberculosis patients had significantly poor modified Barthel index and 3-month outcome. Culture positivity was significantly higher in the disseminated group. Ten (27.02%) out of 37 culture positive tuberculous meningitis cases had multi-drug-resistant tuberculosis. On multivariate analysis disseminated tuberculosis, baseline modified Barthel index ≤12, and stage 3 predicted poor outcome. Fifty-five patients had spinal tuberculosis. Thirty-four (75.56%) patients with Pott's spine improved with antituberculosis treatment and only 11 (24.44%) patients had modified Barthel index ≤12, after 3 months. CONCLUSIONS: In tuberculosis-endemic areas a varied form of CNS tuberculosis is frequent. CNS tuberculosis is often part of disseminated tuberculosis.


Assuntos
Antituberculosos/uso terapêutico , Mielite/epidemiologia , Tuberculoma Intracraniano/epidemiologia , Tuberculose Meníngea/epidemiologia , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Adolescente , Adulto , Quimioterapia Combinada , Feminino , Glucocorticoides/uso terapêutico , Humanos , Índia/epidemiologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Mielite/diagnóstico por imagem , Mielite/tratamento farmacológico , Centros de Atenção Terciária , Tomografia Computadorizada por Raios X , Tuberculoma Intracraniano/diagnóstico por imagem , Tuberculoma Intracraniano/tratamento farmacológico , Tuberculose do Sistema Nervoso Central/diagnóstico por imagem , Tuberculose do Sistema Nervoso Central/tratamento farmacológico , Tuberculose do Sistema Nervoso Central/epidemiologia , Tuberculose Meníngea/diagnóstico por imagem , Tuberculose Meníngea/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico por imagem , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Adulto Jovem
3.
Indian J Tuberc ; 66(1): 81-86, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30797289

RESUMO

BACKGROUND/OBJECTIVES: Spinal tuberculosis (TB) is a destructive extra-pulmonary disease manifestation of Mycobacterium tuberculosis infection. It is responsible for many cases of paraparesis and quadriparesis in developing countries where patients seek treatment late. The aim of this study was to understand and analyze the clinical and radiological profile of patients with spinal TB and correlate it with the anatomical site affected by it. METHODS: A retrospective, observational study of 100 cases of spinal TB admitted over a period of three years. Data on demography, clinical signs and symptoms and investigations were analyzed. RESULTS: Incidence of spinal TB was found to be the highest in the third and fourth decade of life (45%). Incidence among males was 64% and females was 36%. Low socioeconomic class (72%) and past history of pulmonary TB (34%) were found to be risk factors for spinal TB. Average duration between onset of symptoms and time of presentation to the hospital was 154±15.5 days. Patients with bone involvement presented later than those without bone involvement. Paraplegia (91%) and backache (62%) were the most common clinical presentation. Thoracic spine involvement (36%) and vertebral wedging and destruction (58%) were the commonest X-ray findings. 69% patients had compressive lesion with vertebral body destruction being the commonest cause of compression. CONCLUSIONS: Spinal TB with neurological deficits affected the thoracic spine. Compressive spinal cord lesions were the common form of presentation of spinal TB. Paraplegia with backache and neurological bladder-bowel involvement were the most prevalent neuro-deficits. Magnetic resonance imaging of the spine proved to be the most useful investigation to differentiate and localize the site of tubercular lesions.


Assuntos
Fraturas por Compressão/fisiopatologia , Fraturas Espontâneas/fisiopatologia , Paraplegia/fisiopatologia , Quadriplegia/fisiopatologia , Compressão da Medula Espinal/fisiopatologia , Tuberculose do Sistema Nervoso Central/fisiopatologia , Tuberculose da Coluna Vertebral/fisiopatologia , Adulto , Dor nas Costas/etiologia , Feminino , Fraturas por Compressão/diagnóstico por imagem , Fraturas por Compressão/etiologia , Fraturas Espontâneas/diagnóstico por imagem , Fraturas Espontâneas/etiologia , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Mielite/complicações , Mielite/diagnóstico por imagem , Mielite/fisiopatologia , Paraplegia/etiologia , Quadriplegia/etiologia , Radiografia , Estudos Retrospectivos , Compressão da Medula Espinal/etiologia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/etiologia , Tuberculose do Sistema Nervoso Central/complicações , Tuberculose do Sistema Nervoso Central/diagnóstico por imagem , Tuberculose da Coluna Vertebral/complicações , Tuberculose da Coluna Vertebral/diagnóstico por imagem , Adulto Jovem
4.
Curr Probl Diagn Radiol ; 48(6): 547-553, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30385131

RESUMO

PURPOSE: To differentiate intra-axial tuberculomas (TB) from metastases based on quantitative differences in the perfusion and diffusion indices of lesion and perilesional edema using arterial spin labeling (ASL) and diffusion tensor imaging (DTI) techniques. MATERIALS AND METHODS: This prospective study included newly diagnosed untreated 12 patients of TB and 13 of metastases who underwent routine magnetic resonance imaging including DTI and ASL sequences. A region of interest analysis was performed and cerebral blood flow (CBF) values of lesion (L), perilesional edema (PE), and normal contralateral white matter (CWM) were calculated. To account for individual patient variation CBF values were normalized (n) to CWM to obtain the nCBFL and nCBFPE ratios. Similarly, DTI data was processed to obtain fractional anisotropy (FA), mean diffusivity, radial diffusivity, and axial diffusivity values from the lesion and PE. RESULTS: Metastatic lesions revealed statistically significant (p = 0.001) high values of median nCBFL than TB whereas the difference in the median nCBFPE was not statistically significant (p = 0.174). TB showed higher median FAL compared to metastases (p = 0.031) while no statistically significant difference was found in mean values of other diffusion parameters such as mean diffusivity, radial diffusivity and axial diffusivity. Analysis by the receiver operating characteristic curve method revealed a cut-off value of ≥2.865 for nCBFL (Sensitivity = 0.85, Specificity = 0.84, positive predictive value (PPV) = 0.85, Negative predictive value (NPV) = 0.83) and ≤0.073 for FAL (Sensitivity = 0.77, Specificity = 0.58, PPV = 0.67, NPV = 0.70) in differentiating metastases from TB. CONCLUSION: Combined analysis of noncontrast ASL perfusion and DTI technique may markedly benefit in differentiation of TB from metastases.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/secundário , Imagem de Tensor de Difusão/métodos , Tuberculoma/diagnóstico por imagem , Tuberculose do Sistema Nervoso Central/diagnóstico por imagem , Adolescente , Adulto , Idoso , Anisotropia , Diagnóstico Diferencial , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e Especificidade , Marcadores de Spin
6.
Saudi J Kidney Dis Transpl ; 29(3): 719-722, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29970752

RESUMO

A paradoxical reaction during anti-tuberculosis (anti-TB) therapy is commonly reported in patients with human immunodeficiency virus (HIV). However, a similar reaction to anti-TB therapy can also occur in patients without HIV, especially in patients who have undergone solid organ transplantation. A 65-year-old woman who underwent kidney transplantation six months prior presented to our emergency room with progressive paraparesis. She had been diagnosed with drug-susceptible miliary TB and had undergone two weeks of treatment with anti-TB medication. Magnetic resonance imaging showed a spinal intramedullary mass and multiple intracranial nodules. The etiology of the lesions was confirmed as Mycobacterium tuberculosis. We report a paradoxical reaction of spinal intramedullary and multiple intracranial tuberculomas in a patient with miliary TB who had received appropriate treatment for more than two weeks.


Assuntos
Transplante de Rim/efeitos adversos , Tuberculoma , Tuberculose do Sistema Nervoso Central , Idoso , Antituberculosos/uso terapêutico , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Feminino , Humanos , Imagem por Ressonância Magnética , Radiografia Torácica , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/patologia , Tuberculoma/complicações , Tuberculoma/diagnóstico por imagem , Tuberculoma/tratamento farmacológico , Tuberculose do Sistema Nervoso Central/complicações , Tuberculose do Sistema Nervoso Central/diagnóstico por imagem , Tuberculose do Sistema Nervoso Central/tratamento farmacológico , Tuberculose Miliar/complicações , Tuberculose Miliar/tratamento farmacológico
12.
Pediatr Radiol ; 47(10): 1249-1259, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29052770

RESUMO

Tuberculosis in childhood is clinically challenging, but it is a preventable and treatable disease. Risk factors depend on age and immunity status. The most common form of pediatric tuberculosis is pulmonary disease, which comprises more than half of the cases. Other forms make up the extrapulmonary tuberculosis that involves infection of the lymph nodes, central nervous system, gastrointestinal system, hepatobiliary tree, and renal and musculoskeletal systems. Knowledge of the imaging characteristics of pediatric tuberculosis provides clues to diagnosis. This article aims to review the imaging characteristics of common sites for extrapulmonary tuberculous involvement in children.


Assuntos
Diagnóstico por Imagem , Tuberculose/diagnóstico por imagem , Criança , Humanos , Tuberculose do Sistema Nervoso Central/diagnóstico por imagem , Tuberculose Gastrointestinal/diagnóstico por imagem , Tuberculose Hepática/diagnóstico por imagem , Tuberculose dos Linfonodos/diagnóstico por imagem , Tuberculose Osteoarticular/diagnóstico por imagem , Tuberculose Renal/diagnóstico por imagem
16.
Can Assoc Radiol J ; 68(2): 161-170, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28283299

RESUMO

The increasing prevalence of tuberculosis in both immunocompetent and immunocompromised individuals in recent years makes the disease a topic of universal concern. It has insidious onset and can affect virtually any organ system in the body, including the central nervous system (CNS). CNS tuberculosis (TB) is becoming more and more complex and atypical with onset of multidrug-resistant TB. Routine diagnostic techniques using serology and body tissue are time consuming and may delay the definitive management. Hence, it is important to be familiar with various radiologic features of CNS TB to ensure early and accurate diagnosis, thereby reducing high morbidity and mortality associated with the disease. The newer imaging techniques further help to improve the characterization and diagnosis of atypical CNS TB. The authors review the imaging characteristics of different forms of CNS tuberculosis involving the brain and spine and discuss the role of advanced imaging modalities in differentiating CNS TB from other disease process.


Assuntos
Neuroimagem , Tuberculose do Sistema Nervoso Central/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Tomografia Computadorizada por Raios X , Tuberculose do Sistema Nervoso Central/fisiopatologia
17.
Acta Radiol ; 58(1): 91-97, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26936900

RESUMO

BACKGROUND: Ventricular involvement in neurotuberculosis is rare. The literature regarding the characteristics of magnetic resonance imaging (MRI) in ventricular tuberculosis is very limited. PURPOSE: To describe MRI characteristics of ventricular tuberculosis and discuss the medical treatment along with the clinical outcome. MATERIAL AND METHODS: Ten patients (6 men, 4 women; average age, 39 years) were diagnosed with ventricular tuberculosis during a period of 3 years. Four patients had the history of pulmonary/pleural tuberculosis. The clinical and MRI features of these patients were reviewed retrospectively. RESULTS: On a brain MRI, three patients showed ependymitis associated with contrast enhancement of the ependymal lining of the ventricular walls. One patient had choroid plexitis associated with prominent swollen and marked enhancement of the choroid plexus. One patient had intraventricular tuberculoma associated with an intraventricular nodule. Two patients had both ependymitis and choroid plexitis. Three patients had both intraventricular tuberculoma and choroid plexitis. Four patients had hydrocephalus. All patients underwent intrathecal injection of isoniazid and dexamethasone combined with multidrug anti-tuberculosis treatment. All patients had a good clinical recovery, except for one who developed hemi-paralysis due to cerebral infarction. On the repeated MRI of eight patients after therapy, all lesions disappeared or decreased in size, apart from in one patient who showed ventricular separation. CONCLUSION: MRI characteristics of ventricular tuberculosis included ependymal enhancement, swelling, and enhancement of the choroid plexus and intraventricular tuberculomas. Intrathecal injection of isoniazid and dexamethasone along with multidrug chemotherapy showed good efficacy in ventricular tuberculosis.


Assuntos
Ventrículos Cerebrais/diagnóstico por imagem , Ventriculite Cerebral/diagnóstico por imagem , Ventriculite Cerebral/tratamento farmacológico , Imagem por Ressonância Magnética/métodos , Tuberculose do Sistema Nervoso Central/diagnóstico por imagem , Tuberculose do Sistema Nervoso Central/tratamento farmacológico , Adulto , Antituberculosos/uso terapêutico , Ventrículos Cerebrais/efeitos dos fármacos , Monitoramento de Medicamentos/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
18.
Monaldi Arch Chest Dis ; 87(3): 838, 2017 09 28.
Artigo em Inglês | MEDLINE | ID: mdl-29424197

RESUMO

Pregabalin, widely used in the treatment of several pain disorders, is usually well tolerated. Uncommonly, the drug may induce cardiac side effects, rarely prolongation of the PR interval. The latter has never been described in patients with healthy heart or normal renal function. We characterize a unique case of a young man with extrapulmonary tuberculosis and no detectable or known cardiac or kidney diseases, treated with pregabalin to control the severe pain due to the involvement of the spinal cord by the tuberculosis, showing an atrioventricular (AV) block due to pregabalin administration. The reported case emphasizes the need of monitoring PR interval during treatment with pregabalin, even in patients without background of cardiac or renal diseases.


Assuntos
Bloqueio Atrioventricular/induzido quimicamente , Dor/tratamento farmacológico , Pregabalina/efeitos adversos , Tuberculose do Sistema Nervoso Central/complicações , Bloqueio Atrioventricular/fisiopatologia , Bloqueadores dos Canais de Cálcio/administração & dosagem , Bloqueadores dos Canais de Cálcio/efeitos adversos , Bloqueadores dos Canais de Cálcio/uso terapêutico , Eletrocardiografia/instrumentação , Humanos , Masculino , Pregabalina/administração & dosagem , Pregabalina/uso terapêutico , Resultado do Tratamento , Tuberculose do Sistema Nervoso Central/diagnóstico por imagem , Tuberculose do Sistema Nervoso Central/tratamento farmacológico , Tuberculose do Sistema Nervoso Central/patologia , Adulto Jovem
19.
Zhonghua Jie He He Hu Xi Za Zhi ; 39(9): 719-22, 2016 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-27600423

RESUMO

OBJECTIVE: To study the MRI features of ventricular system tuberculosis. METHODS: Nineteen patients with ventricular system tuberculosis in our hospital from Mar. 2009 to Sep. 2014 were retrospectively identified. Their clinical features and cranial MRI characteristics were reviewed. RESULTS: There were 13 males and 6 females, aged from 15-81 years(mean 37±16). Eight patients had intraventricular tuberculosis, with 5 long striped or irregular shaped intraventricular tuberculosis and 3 with ventricular tuberculoma. Six patients had tubercular ependymitis and 5 had intraventricular tuberculosis along with tubercular ependymitis. The lesions of 14 patients were in the lateral ventricle; 13 in occipital or temporal horn of lateral ventricle, 9 complicated by tubercular meningitis, and 10 complicated by brain tuberculoma. The lesion of 5 patients were in the fourth ventricle, 5 in the postmedian of the fourth ventricle, 5 complicated by tubercular meningitis and 4 complicated by hydrocephalus. There were 4 cases with ring-enhancement and 15 with heterogeneous enhancement. Ten cases were complicated by peripheral edema. CONCLUSIONS: The diagnosis of ventricle system tuberculosis is difficult due to its low incidence. The site, cranial MRI characteristics, the patterns of enhancement and complications have certain specificity and are useful in the diagnosis of ventricular system tuberculosis.


Assuntos
Ventrículos Cerebrais/diagnóstico por imagem , Ventriculite Cerebral/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Tuberculoma Intracraniano/diagnóstico por imagem , Tuberculoma/complicações , Tuberculose do Sistema Nervoso Central/diagnóstico por imagem , Tuberculose Meníngea/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA