Tuberculosis of the nervous system

Tuberculosis of the nervous system /THC/ – this represents an extremely severe form of this infectious disease, which hides a serious danger to life. Even in the presence of appropriate antituberculosis therapy, the development of this disease leads to high rates of morbidity and even mortality.

Despite the development of promising molecular methods for the diagnosis of tuberculosis, the diagnosis of tuberculosis of the nervous system relies heavily on microbiological methods , which are insensitive and precisely because of this, this form of infectious lung disease remains a real diagnostic challenge.

Although the world’s most widely used vaccine largely targets this manifestation of tuberculosis, the BCG vaccine has failed to fulfill its creators’ promise of eliminating the neuropathogenic form of the disease.

The disease of the central nervous system is caused by Mycobacterium tuberculosis, which is a rare but extremely dangerous form of tuberculosis. The neuropathogenic form of tuberculosis is the cause of approximately 1% of all cases of pulmonary infectious disease.

This form of tuberculosis has a high mortality rate and disproportionately affects children and people with human immunodeficiency virus.

What are the symptoms?

In adults, THC most often presents with classic meningitis symptoms—fever, headache, and neck stiffness along with focal neurologic deficits, behavioral changes, and hallucinations.

In children, THC mainly presents with high fever, neck stiffness and abdominal symptoms such as nausea and vomiting. The headache is less pronounced than in adults.

Depending on the stage of manifestation of THC, neurological symptoms in children vary from lethargy and agitation to coma. Some scientists believe that THC in children develops most often within 3 months of the onset of primary tuberculosis infection.

A family history is found in 50-60% of children, and a positive skin test is found in 30 to 50% of them.

In childhood, the symptoms of THC often appear more quickly, and parents seek medical attention within hours to weeks of the onset of symptoms.

Typical THC goes like this:

• First stage – the patient is fully conscious and without focal deficits;
• Second stage – conscious, but distracted, confused, lost and with focal neurological signs such as paralysis of the cranial nerves.
• Third stage – multiple cranial nerve palsies or many hemiparesis or paralysis.

Treatment of tuberculosis of the nervous system

Antibiotic therapy

The standard approach to this disease includes an initial 2-month regimen of induction therapy, in which the following medications are administered – isoniazid, rifampin, pyrazinamide, and ethambutol. Subsequently, isoniazid and rifampin are prescribed for a period of 7 to 10 as maintenance therapy.

But the first remains the basis of THC treatment. Rifampin and ethambutol significantly less penetrate the central nervous system, although they are essential for the treatment of the neuropathogenic form of tuberculosis.

The use of corticosteroids as an adjunctive therapy in the treatment of THC began as early as the 1950s, but to this day their appointment remains controversial.

Originally, the rationale for using steroids involved reducing inflammation in the subarachnoid space.

However, concerns about damaging cellular defenses against the tuberculosis bacterium and potentially reducing the penetration of steroids into the central nervous system have always meant that this mode of adjunctive treatment was not preferred.

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