Tuberculous Meningitis: Manual of Diagnosis and Therapy

122 Pages·2020·7.21 MB·English

by  Jerome H Chin (editor)

Tuberculous Meningitis
Tuberculous Meningitis
Manual of Diagnosis and Therapy
Editedby
JEROME HSI-CHENG CHIN
Department of Neurology, NYU Langone Health,
New York, NY, United States
AcademicPressisanimprintofElsevier
125LondonWall,LondonEC2Y5AS,UnitedKingdom
525BStreet,Suite1650,SanDiego,CA92101,UnitedStates
50HampshireStreet,5thFloor,Cambridge,MA02139,UnitedStates
TheBoulevard,LangfordLane,Kidlington,OxfordOX51GB,UnitedKingdom
Copyright©2020ElsevierInc.Allrightsreserved.
Nopartofthispublicationmaybereproducedortransmittedinanyformorbyanymeans,
electronicormechanical,includingphotocopying,recording,oranyinformationstorageand
retrievalsystem,withoutpermissioninwritingfromthepublisher.Detailsonhowtoseek
permission,furtherinformationaboutthePublisher’spermissionspoliciesandour
arrangementswithorganizationssuchastheCopyrightClearanceCenterandtheCopyright
LicensingAgency,canbefoundatourwebsite:www.elsevier.com/permissions.
Thisbookandtheindividualcontributionscontainedinitareprotectedundercopyrightby
thePublisher(otherthanasmaybenotedherein).
Notices
Knowledgeandbestpracticeinthisfieldareconstantlychanging.Asnewresearchand
experiencebroadenourunderstanding,changesinresearchmethods,professionalpractices,
ormedicaltreatmentmaybecomenecessary.
Practitionersandresearchersmustalwaysrelyontheirownexperienceandknowledgein
evaluatingandusinganyinformation,methods,compounds,orexperimentsdescribed
herein.Inusingsuchinformationormethodstheyshouldbemindfuloftheirownsafety
andthesafetyofothers,includingpartiesforwhomtheyhaveaprofessionalresponsibility.
Tothefullestextentofthelaw,neitherthePublishernortheauthors,contributors,or
editors,assumeanyliabilityforanyinjuryand/ordamagetopersonsorpropertyasamatter
ofproductsliability,negligenceorotherwise,orfromanyuseoroperationofanymethods,
products,instructions,orideascontainedinthematerialherein.
BritishLibraryCataloguing-in-PublicationData
AcataloguerecordforthisbookisavailablefromtheBritishLibrary
LibraryofCongressCataloging-in-PublicationData
AcatalogrecordforthisbookisavailablefromtheLibraryofCongress
ISBN:978-0-12-818825-5
ForInformationonallAcademicPresspublications
visitourwebsiteathttps://www.elsevier.com/books-and-journals
Publisher:NikkiLevy
AcquisitionsEditor:MelanieTucker
EditorialProjectManager:SaraPianavilla
ProductionProjectManager:
SujathaThirugnanaSambandam
CoverDesigner:MarkRogers
TypesetbyMPSLimited,Chennai,India
Contents
Listofcontributors ix
Preface xi
1. Global andregional burden of tuberculosis andtuberculous
meningitis 1
AlexandraBoubour,MandarParadkarandKiranT.Thakur
Globaltuberculosisepidemiology 1
Regionaltuberculosisepidemiology 3
Centralnervoussystemtuberculosis 6
WorldHealthOrganizationmanagementgoals 9
Conclusion 11
References 11
2. Immunopathology of Mycobacterium tuberculosis complex 17
WillySsengoobaandJeromeH.Chin
Biologyoftuberculosis 17
Mycobacteriumtuberculosiscomplexandthepathogenesisoftuberculosis 18
GeneticdiversityofMycobacteriumtuberculosisandtuberculousmeningitis 19
Host(cid:1)pathogeninteractionsandthepathogenesisoftuberculousmeningitis 20
Conclusion 21
References 22
3. Clinical presentationsandfeatures of tuberculousmeningitis 25
JeromeH.Chin
Symptomsoftuberculousmeningitis 25
Clinicalsignsoftuberculosisandtuberculousmeningitis 26
Cerebrospinalfluidoftuberculousmeningitis 28
Neuroimagingoftuberculousmeningitis 29
Conclusion 34
References 35
v
vi Contents
4. Laboratory methodsfor detectingtuberculosis and tuberculous
meningitis 37
JeromeH.ChinandWillySsengooba
Biosafety 38
Cerebrospinalfluidcollection 39
Routinecerebrospinalfluidstudies 41
Directmicroscopyfordiagnosisoftuberculosis 44
CommercialnucleicacidamplificationtestsforMycobacteriumtuberculosis
detection 44
Adenosinedeaminasetestandlipoarabinomannanlateralflowassay 47
Next-generationsequencing 48
Immunologicalassays 48
References 49
5. Identification of Mycobacterium tuberculosis drug resistance 53
WillySsengoobaandJeromeH.Chin
Globalburdenoftuberculosisanddrugresistance 53
Mechanismsofresistancetoantituberculosisdrugs 54
Drugresistancedeterminationmethods:strengthsandlimitations 54
Culture-baseddrug-susceptibilitytestingforMycobacteriumtuberculosis 57
DNA-basedtuberculosisdrug-susceptibilitytestingmethods 62
References 65
6. Treatment guidelines for tuberculosis and tuberculousmeningitis 67
FionaV.Cresswell,AbduK.MusubireandKatarinaM.JohanssonÅrhem
Drug-susceptibletuberculosistreatment 67
Treatmentofdrug-resistanttuberculosis 83
Corticosteroidsandhost-directedtherapiesfortuberculousmeningitis 87
Complicationsoftuberculousmeningitis 88
References 97
Furtherreading 101
7. Neurosurgical management of tuberculousmeningitis 103
PeterSsenyonga
Introduction 103
Hydrocephalus 103
Radiology 104
Medicalmanagementofhydrocephalus 104
Contents vii
Surgicalmanagementofhydrocephalus 105
Outcomes 106
Tuberculomas 106
References 107
8. Evidence gaps andfuture directions 111
JeromeH.Chin
References 112
Index 113
List of contributors
AlexandraBoubour
DepartmentofNeurology,ColumbiaUniversityIrvingMedicalCenter,NewYork,NY,
UnitedStates
JeromeH.Chin
DepartmentofNeurology,NYULangoneHealth,NewYork,NY,UnitedStates
FionaV.Cresswell
ClinicalResearchDepartment,LondonSchoolofHygieneandTropicalMedicine,
London,UnitedKingdom;InfectiousDiseasesInstitute,CollegeofHealthSciences,
MakerereUniversity,Kampala,Uganda;MRC-UVRI-LSHTMUgandaResearchUnit,
Entebbe,Uganda
KatarinaM.JohanssonÅrhem
DepartmentofInfectiousDiseases,KarolinskaUniversityHospital,Stockholm,Sweden
AbduK.Musubire
InfectiousDiseasesInstitute,CollegeofHealthSciences,MakerereUniversity,Kampala,
Uganda;DepartmentofMedicine,SchoolofMedicine,CollegeofHealthSciences,
MakerereUniversity,Kampala,Uganda
MandarParadkar
BJGovernmentMedicalCollege,JohnsHopkinsUniversityClinicalResearchSite,Pune,
India
WillySsengooba
MycobacteriologyUnit,DepartmentofMedicalMicrobiology,MakerereUniversity,
Kampala,Uganda
PeterSsenyonga
DepartmentofNeurosurgery,MulagoNationalReferralHospital,Kampala,Uganda
KiranT.Thakur
DepartmentofNeurology,ColumbiaUniversityIrvingMedicalCenter,NewYork,NY,
UnitedStates
ix
Preface
When I closed my private neurology practice in California, United States,
to embark on a career in global/international health, I had no idea where
I would be working and what diseases I would be treating. Eleven years
later, I am the editor and a contributor to this first-ever medical book
devoted to the diagnosis and treatment of tuberculous meningitis.
Tuberculosis is the oldest microbiologically confirmed infectious dis-
ease of humans and is now the leading infectious disease killer in the
world. Tuberculosis is a global transmissible disease that can affect any per-
son of any age. As a clinical neurologist teaching and treating patients in
Africa, Asia, and the United States, I am keenly aware of the challenges of
diagnosing and treating central nervous system infections, especially in
health-care settings with limited laboratory services and constrained access
to effective medications. The diagnosis and treatment of tuberculous men-
ingitis is particularly challenging due to many factors, resulting in substan-
tial mortality and morbidity.
I am deeply grateful to my colleagues and collaborators who have
contributed their knowledge and experience to this endeavor. We have
written this concise and clinically focused book to be a practical manual
to assist and guide clinicians involved in evaluation and management of
patients with neurological infections. My international work and this
book could not have been possible without the love and support of my
wife and two children. Lastly, I thank my patients and their families for
the privilege of being their physician and for the trust they place in me to
care for them to the best of my abilities.
Jerome Hsi-Cheng Chin
xi
CHAPTER 1
Global and regional burden of
tuberculosis and tuberculous
meningitis
Alexandra Boubour1, Mandar Paradkar2 and Kiran T. Thakur1
1DepartmentofNeurology,ColumbiaUniversityIrvingMedicalCenter,NewYork,NY,UnitedStates
2BJGovernmentMedicalCollege,JohnsHopkinsUniversityClinicalResearchSite,Pune,India
Key points
(cid:129) Tuberculosis(TB)isaglobaldiseaseandtheleadinginfectiousdiseasekillerin
theworld.
(cid:129) ThehighestincidenceestimatesforTBareintheWorldHealthOrganization
AfricanandSoutheastAsiaRegions.
(cid:129) Inlow-burdencountriesthemajorityofTBcasesareforeign-bornpersonsfrom
high-burdencountries.
(cid:129) TBistheleadingcauseofdeathforHIV-infectedpersons.
(cid:129) Tuberculousmeningitisisestimatedtoaccountfor1%(cid:1)2%ofallnewcasesof
TBalthoughreliablepopulation-baseddataarelimited.
Global tuberculosis epidemiology
Prevalence and incidence
Tuberculosis (TB) is the leading infectious cause of death on a global
level, caused by Mycobacterium tuberculosis (MTB) [1,2]. According to
World Health Organization (WHO) estimates, approximately 10 million
(range, 9.0(cid:1)11.1 million) incident cases of TB and 1.6 million TB deaths
occurred in 2017, a small percentage decline from prior years (Fig. 1.1)
[1]. Since 2000, global TB incidence has declined by 1.5% per year on
average [1]. As of 2017, the incidence and number of TB cases remained
greatest in the WHO Southeast Asia and African regions despite regional
efforts for case reduction [1,3]. Nine percent of incident cases (920,000)
occurred among HIV-positive people, 72% living in the African region
[1]. Given these estimates, global TB incidence is not currently on track
to meet the 2020 WHO End TB Strategy and United Nations (UN)
Sustainable Development Goals (SDGs), which propose a 20% decrease in
TuberculousMeningitis ©2020ElsevierInc.
DOI:https://doi.org/10.1016/B978-0-12-818825-5.00001-2 Allrightsreserved. 1