Multi drug resistant (MDR) tuberculous meningitis with hydrocephalus treated with ventriculo-peritoneal shunting: a review

  • Authors

    • Vinod Gautam IHBAS, Delhi, India
    • Sarbjeet Khurana IHBAS, Delhi, India
    • Ravinder Singh IHBAS, Delhi, India
    2015-03-17
    https://doi.org/10.14419/ijm.v3i1.4349
  • CNS Tuberculosis, Multi drug resistance, Ventriculo-peritoneal shunt.

  • Abstract

    Introduction: Tubercular meningitis (TBM) is one of the severe manifestations of extra pulmonary tuberculosis. Prognosis of cases of multidrug resistance TBM is even worse. We present report of three cases of MDR tuberculous meningitis with hydrocephalus to highlight the challenges in the management of these patients.

    Materials and Methods: The present study was done was done at IHBAS, a tertiary care neuropsychiatry hospital in Delhi, India. Three patients of MDR CNS TB treated at neurosurgery department were included in this study. Study design was a descriptive case series.

    Results: All three cases were treated with second line ATT and ventrriculoperitoneal shunting. After a regular follow up with clinical and neuroimaging vigil and with laboratory testing, these patients showed improvement.

    Conclusion: The decision to start second line ATT to treat resistant cases of CNS TB is often delayed and increases the morbidity and mortality. Prompt and precise decision is possible with vigilant clinical observation, lab tests and neuroimaging. Close follow-up is mandatory for detecting any adverse drug effect and therapeutic response in patients of MDR-CNS TB.

    Author Biography

    • Vinod Gautam, IHBAS, Delhi, India
      Assistant Professor Neurosurgery

  • References

    1. [1] Grange J M, Zumla A. Paradox of the global emergence of tuberculosis. Lancet. 1999; 353: 996. http://dx.doi.org/10.1016/S0140-6736(99)01196-4.

      [2] Chandramukhi A, Lyashchenko K, Kumari HB, et al. Detection of antibodies to Mycobacterium tuberculosis protein antigen in cerebrospinal fluid of patients with tuberculous meningitis. J INF Dis. 2002; 186 (5):678-83.) http://dx.doi.org/10.1086/342293

      [3] GB Migliori, R Loddenkemper, F Blasi and MC Raviglione. 125 years after Robert Koch's discovery of the tubercle bacillus: the new XDR-TB threat. Is "science" enough to tackle the epidemic? Eur Respir J 2007; 29: 423-427. http://dx.doi.org/10.1183/09031936.00001307.

      [4] Murthy J. Multi-drug-resistant central nervous system tuberculosis. Neurol India 2012; 60:143-145 http://dx.doi.org/10.4103/0028-3886.96381.

      [5] WHO. Global tuberculosis report 2014. Geneva, Switzerland.

      [6] Thomas F. Byrd, Larry E. Davis. Multidrug-resistant tuberculous meningitis. Current eurology and Neuroscience Reports. November 2007, Volume 7, Issue 6, pp 470-475.

      [7] Murthy J. Tuberculous meningitis: The challenges. Neurol India 2010; 58:716-722 http://dx.doi.org/10.4103/0028-3886.72178.

      [8] Thwaites, G. E., Bang N. D., Dung N. H., et al. 2005. The influence of HIV infection on clinical presentation, response to treatment, and outcome in adults with tuberculous meningitis. J. Infect. Dis.192:2134–2141. http://dx.doi.org/10.1086/498220.

      [9] Gautam VKS, Khurana S., Singh R. Diagnostic and therapeutic challenges in the surgical management of CNS tuberculosis. Int J Med Health Sci. 2013, 2, 161-169.

      [10] P. Kamra, R. Azad, K.N. Prasad, S. Jha, S. Pradhan, R.K. Gupta. Infectious meningitis: prospective evaluation with magnetization transfer MRI. British Journal of Radiology, 77, 2004, 387–94. http://dx.doi.org/10.1259/bjr/23641059.

      [11] Gautam VKS, Singh R, Khurana S. Reviewing Hydrocephalus: Personal experience of a neurosurgeon with ventriculoperitoneal shunts treatment. International Journal of Medicine, 2, 2014, 56-59. http://dx.doi.org/10.14419/ijm.v2i2.3219.

      [12] NICE, 2006.http://www.nice.org.uk/guidance.

      [13] WHO Report: Treatment of tuberculosis guidelines. 4th ed. 2010.

      [14] WHO Report, 2006. www.who.int/maternal_child_adolescent.

      [15] Lawn SD, Brooks SV, Kranzer K, Nicol MP, Whitelaw A, et al. Screening for HIV- associated tuberculosis and rifampicin resistance before antiretroviral therapy using the Xpert MTB/RIF assay: A prospective study. PLoS Med 2011;8: e1001067 http://dx.doi.org/10.1371/journal.pmed.1001067.

      [16] Scott LE, McCarthy K, Gous N, Nduna M, Van Rie A, et al. Comparison of Xpert MTB/RIF with other nucleic acid technologies for diagnosing pulmonary tuberculosis in a high HIV prevalence setting: A prospective study. PLoS Med 2011;8: e1001061 http://dx.doi.org/10.1371/journal.pmed.1001061.

      [17] Central TB Division (CTD), Directorate General of Health 2. Services, Ministry of Health and Family Welfare, Government of India. DOTS-plus guidelines. New Delhi: CTD; 2006.

      [18] http://www.tbfacts.org/drug-susceptibility.html.

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  • How to Cite

    Gautam, V., Khurana, S., & Singh, R. (2015). Multi drug resistant (MDR) tuberculous meningitis with hydrocephalus treated with ventriculo-peritoneal shunting: a review. International Journal of Medicine, 3(1), 22-25. https://doi.org/10.14419/ijm.v3i1.4349

    Received date: 2015-02-13

    Accepted date: 2015-03-09

    Published date: 2015-03-17