CNS tuberculosis: diagnostic challenges and review of recent laboratory investigations

  • Authors

    • Vinod Gautam Department of Neurosurgery,IHBAS, Delhi, India
    • Renu Gupta Department of Microbiology,IHBAS
    2017-02-17
    https://doi.org/10.14419/ijm.v5i1.5774
  • CNS, Tuberculosis, Laboratory Investigations

  • Abstract

    Tuberculosis of the central nervous system poses a diagnostic and therapeutic challenge to the physicians. Early diagnosis is warranted to reduce morbidity and mortality associated with this disease. Microbiological investigations for the diagnosis of tuberculosis of central nervous system are of paramount significance. However, due to relative inaccessibility of approaching infected lesions in eloquent area of brain and difficulty in retrieving pathological sample from deep located regions of the brain and spinal cord without causing any neurological deficit, there is need to review the relevance of available microbiological and biochemical tests. Some tests which may be very specific like AFB microscopy and culture may not be positive in many cases due to paucibacillary CSF sample or pus or granulation tissue from the brain or spine. So, authors have reviewed different biochemical and microbiological tests and suggested a pragmatic and step wise practical approach for use of laboratory investigations in clinical management of CNS TB patients.

    Author Biography

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

  • References

    1. [1] Gautam VKS, Khurana S, Singh R (2013) Diagnostic and therapeutic challenges in the surgical management of CNS tuberculoma, International Journal of Medicine & Health Sciences, April 2013, Vol-2; Issue-2, 161-169.

      [2] Malik Z I, Ishtiaq O, Shah N H, Anwer F &Baqai H Z ( 2002) Analysis and outcome of 30 patients with Tuberculous Meningitis.Pakistan Journal of Medical Research; Vol.41 No.4, 137-41.

      [3] Naughten E, Weindling A M, Newton R &. Bower B D (1981) Tuberculous meningitis in children. Recent experience in two English centres. Lancet. Oct, 31; 2 (8253):973–975.http://dx.doi.org/10.1016/s0140-6736(81)91166-1.

      [4] Kent S J, Crowe S M, Yung A, Lucas C R &MijchA M (1993) Tuberculous meningitis: a 30-year review. Clinical Infectious Diseases. 17:987–994. http://dx.doi.org/10.1093/clinids/17.6.987.

      [5] Verdon R, Chevret S, Laissy J P & Wolff M (1996). Tuberculous meningitis in adults: review of 48 cases. Clinical Infectious Diseases. 22:982–988.http://dx.doi.org/10.1093/clinids/22.6.982.

      [6] Thwaites G E, Chau T T& Farrar J J (2004). Improving the bacteriological diagnosis of tuberculous meningitis. Journal of Clinical Microbiology. 42:378–379.http://dx.doi.org/10.1128/JCM.42.1.378-379.2004.

      [7] Thwaites G E, Caws M, Chau T T, Dung N T, Campbell J I, Phu N H,Hien T T, White N J & Farrar J J (2004). Comparison of conventional bacteriology with nucleic acid amplification (amplified mycobacterium direct test) for diagnosis of tuberculous meningitis before and after inception of antituberculosis chemotherapy. Journal of Clinical Microbiology. 42: 996–1002.http://dx.doi.org/10.1128/JCM.42.3.996-1002.2004.

      [8] Jeren, T &Beus I (1982). Characteristics of cerebrospinal fluid in tuberculous meningitis. ActaCytologica. 26:678–680.

      [9] Sutlas P N, Unal A, Forta H, Senol S, &Kirbas D (2003). Tuberculous meningitis in adults: review of 61 cases. Infection 31:387–391.

      [10] Updated guidelines for the use of Nucleic acid amplification tests in the diagnosis of tuberculosis, http://www.cdc.gov/tb MMWR weekly January 16, 2009/58(01); 7-10.

      [11] Cherian A, Thomas SV. Central nervous system tuberculosis. African Health Sciences Vol 11, No.1, March 2011, 116-127.

      [12] Kashyap R S, Kainthla R P, Satpute R M, Agarwal N P, Chandak N H, Purohit H J, Taori G M &Daginawala H F (2004). Differential diagnosis of tuberculous meningitis from partially-treated pyogenic meningitis by cell ELISA. BMC Neurology. 4:16.http://dx.doi.org/10.1186/1471-2377-4-16.

      [13] Kashyap R S, Kainthla R P, Mudaliar A V,Purohit H J, Taori G M, &Daginawala H F (2006). Cerebrospinal fluid adenosine deaminase activity: a complementary tool in the early diagnosis of tuberculous meningitis. Cerebrospinal Fluid Research. March 30, 3: 5.

      [14] Rock RB, Olin M, Baker CA, Molitor TW& Peterson PK (2008). Central nervous system tuberculosis: pathogenesis and clinical aspects. Clinical Microbiology Reviews.Apr; 21(2):243-61http://dx.doi.org/10.1128/CMR.00042-07.

      [15] French G L, Teoh R, Chan C Y, Humphries M J, Cheung S W &O’Mahony G (1987) Diagnosis of tuberculous meningitis by detection oftuberculostearic acid in cerebrospinal fluid. Lancet.July 18; 2(8551):117–119.

      [16] Thwaites G, Fisher M, Hemingway C, Scott G, Solomon T, Innes J. British infection society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children. Journal of Infection (2009), 59, 167-187.http://dx.doi.org/10.1016/j.jinf.2009.06.011.

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  • How to Cite

    Gautam, V., & Gupta, R. (2017). CNS tuberculosis: diagnostic challenges and review of recent laboratory investigations. International Journal of Medicine, 5(1), 56-61. https://doi.org/10.14419/ijm.v5i1.5774

    Received date: 2016-01-19

    Accepted date: 2016-02-10

    Published date: 2017-02-17