Nörotüberküloz
Özet
Tüberkülozun en ciddi akciğer dışı tutulum formu olan nörotüberküloz, özellikle beş yaş altı çocuklarda yüksek mortalite ve morbidite riski taşıyan, klinik bulguları özgül olmayan ve erken tanısı güç bir hastalıktır. COVID-19 pandemisi ile birlikte tüberküloz hizmetlerine erişimin zorlaşması, tanı oranlarını düşürerek tüberküloz kaynaklı ölümlerde artışa yol açmıştır. Hastalığın temel patogenezi basilin santral sinir sistemine hematojen yayılımına dayanmakta olup, klinik spektrumunda menenjit, tüberkülom ve ensefalopati gibi tablolar yer almaktadır. Tedavi süreci, yoğun ve idame aşamalarından oluşan antitüberküloz ilaç rejimi ile yürütülmekte olup, hidrosefali gibi komplikasyonların yönetiminde erken müdahale hayati önem taşımaktadır.
Neurotuberculosis, the most serious form of extrapulmonary tuberculosis, poses a high risk of mortality and morbidity, especially in children under five, and remains difficult to diagnose early due to non-specific clinical symptoms. The COVID-19 pandemic has hindered access to tuberculosis services, resulting in decreased diagnosis rates and an increase in tuberculosis-related deaths. The pathogenesis of the disease is based on the hematogenous spread of the bacillus to the central nervous system, manifesting in a clinical spectrum that includes meningitis, tuberculomas, and encephalopathy. The treatment process involves an anti-tuberculosis drug regimen consisting of intensive and maintenance phases, where early intervention is crucial for managing complications such as hydrocephalus.
Referanslar
WHO. Executive summary report, 2020.
Türk Sağlık ve Tedavi Vakfının konferans özetleri: Tüberküloz bildirisi. Ankara, Türkiye. Türkiye'de Tüberkülozun Durumu, 3 Ekim 1988: 3-10.
Sağlık Bakanlığı Sağlık İstatistikleri. Ankara, 1988.
Bilgiç H. Türkiye'de tüberkülozun epidemiyolojisi. Kocabaş A (ed). Tüberkülozun kontrolu ve klinigi. Adana, Türkiye. Emel Basımevi, 1991: 401-438.
Ducomble T, Tolksdorf K, Karagiannis I, et al.: The burden of extrapulmonary and meningitis tuberculosis: an investigation of national surveillance data, Germany, 2002 to 2009. Euro Surveill. 2013; 18(12): pii: 20436.
Seddon JA, Hesseling AC, Marais BJ, et al. The evolving epidemic of drug- resistant tuberculosis among children in Cape Town, South Africa. Int J Tuberc Lung Dis. 2012; 16(7): 928–933.
Seddon JA, Tugume L, Solomons R, Prasad K, Bahr NC; Tuberculous Meningitis International Research Consortium.The current global situation for tuberculous meningitis: epidemiology, diagnostics, treatment and outcomes. Wellcome Open Res. 2019 Nov 5;4:167.
Yaramiş A, Gurkan F, Elevli M et al. MA.Central nervous system tuberculosis in children: a review of 214 cases. Pediatrics. 1998 Nov;102(5):E49.
Lincoln EM: Tuberculous meningitis in children; with special reference to serous meningitis; serous tuberculous meningitis. Am Rev Tuberc. 1947; 56(2): 75–94.
O'Garra A, Redford PS, McNab FW, et al. The immune response in tuberculosis. Annu Rev Immunol. 2013; 31: 475–527.
Krishnan N, Robertson BD, Thwaites G. The mechanisms and consequences of the extra-pulmonary dissemination of Mycobacterium tuberculosis. Tuberculosis (Edinb). 2010; 90(6): 361–366.
Jain SK, Paul-Satyaseela M, Lamichhane G, et al. Mycobacterium tuberculosis invasion and traversal across an in vitro human blood-brain barrier as a pathogenic mechanism for central nervous system tuberculosis. J Infect Dis. 2006; 193(9): 1287–1295.
Be NA, Kim KS, Bishai WR, et al. Pathogenesis of central nervous system tuberculosis. Curr Mol Med. 2009; 9(2): 94–99.
Nguyen L, Pieters J. The Trojan horse: survival tactics of pathogenic mycobacteria in macrophages. Trends Cell Biol. 2005; 15(5): 269–276.
Rich AR, McCordock HA. The pathogenesis of tuberculous meningitis. Bull Johns Hopkins Hospital. 1933; 52: 5–37.
Donald PR, Schaaf HS, Schoeman JF. Tuberculous meningitis and miliary tuberculosis: the Rich focus revisited. J Infect. 2005; 50(3): 193–195.
Dev N, Bhowmick M, Chaudhary S, Kant J. Tuberculous encephalopathy without meningiti: A rare manifestation pf disseminated tuberculosis. Int J Mycobacteriol. 2019 Oct-Dec;8(4):406-408.
Garg RK, Somvanshi DS. Spinal tuberculosis: a review. J Spinal Cord Med 2011;34(05):440–454
Rajajee S, Narayanan PR. Immunological spectrum of childhood tuberculosis. J Trop Pediatr 1992; 38: 31-33
van Well GT, Paes BF, Terwee CB, et al. Twenty years of pediatric tuberculous meningitis: a retrospective cohort study in the western cape of South Africa. Pediatrics. 2009; 123(1): e1–8.
Marais BJ, Gie RP, Schaaf HS, et al. The natural history of childhood intra- thoracic tuberculosis: a critical review of literature from the pre-chemotherapy era. Int J Tuberc Lung Dis. 2004; 8(4): 392–402.
Trunz BB, Fine P, Dye C. Effect of BCG vaccination on childhood tuberculous meningitis and miliary tuberculosis worldwide: a meta-analysis and assessment of cost-effectiveness. Lancet. 2006; 367(9517): 1173–1180.
Mangtani P, Abubakar I, Ariti C, et al. Protection by BCG vaccine against tuberculosis: a systematic review of randomized controlled trials. Clin Infect Dis. 2014; 58(4): 470–480.
Kelekçi S, Karabel M, Karabel D, et al. Bacillus Calmette-Guérin is a preventive factor in mortality of childhood tuberculous meningitis. Int J Infect Dis. 2014; 21: 1–4.
Fine PE: Variation in protection by BCG: implications of and for heterologous immunity. Lancet. 1995; 346(8986): 1339–1345.
Arregui S, Sanz J, Marinova D, et al. On the impact of masking and blocking hypotheses for measuring the efficacy of new tuberculosis vaccines. PeerJ. 2016; 4: e1513.
Bar-Shavit Z, Teitelbaum SL, Reitsma P, et al. Induction of monocytic differentiation and bone resorption by 1,25-dihydroxyvitamin D3. Proc Natl Acad Sci U S A. 1983; 80(19): 5907–5911.
Chandra G, Selvaraj P, Jawahar MS, et al. Effect of vitamin D3 on phagocytic potential of macrophages with live Mycobacterium tuberculosis and lymphoproliferative response in pulmonary tuberculosis. J Clin Immunol. 2004; 24(3): 249–257.
Rigby WF, Shen L, Ball ED, et al. Differentiation of a human monocytic cell line by 1,25-dihydroxyvitamin D3 (calcitriol): a morphologic, phenotypic, and functional analysis. Blood. 1984; 64(5): 1110–1115.
Rizvi I, Garg RK, Jain A, et al. Vitamin D status, vitamin D receptor and toll like receptor-2 polymorphisms in tuberculous meningitis: a case-control study. Infection. 2016; 44(5): 633–640.
Faksri K, Drobniewski F, Nikolayevskyy V, et al. Epidemiological trends and clinical comparisons of Mycobacterium tuberculosis lineages in Thai TB meningitis. Tuberculosis (Edinb). 2011; 91(6): 594–600.
Hang NT, Maeda S, Lien LT, et al. Primary drug-resistant tuberculosis in Hanoi, Viet Nam: present status and risk factors. PLoS One. 2013; 8(8): e71867.
Huyen MN, Buu TN, Tiemersma E, et al. Tuberculosis relapse in Vietnam is significantly associated with Mycobacterium tuberculosis Beijing genotype infections. J Infect Dis. 2013; 207(10): 1516–1524.
Hang NT, Maeda S, Keicho N, et al. Sublineages of Mycobacterium tuberculosis Beijing genotype strains and unfavorable outcomes of anti-tuberculosis treatment. Tuberculosis (Edinb). 2015; 95(3): 336–342.
Starke JR. Tuberculosis. In: Behrman RE, Kliegman RM, Arvin AM (eds). Nelson Textbook of Pediatrics (15th ed). Philadelphia: WB Saunders 1996: 834-847.
Donald PR, Cotton MF, Hendricks MK, Schaaf HS, de Villiers IN, Willemse TE. Pediatric meningitis in the Western Cape Province of South Africa. J Trop Pediatr 1996; 42: 256-261.
Lincoln EM, Sordillo SV, Davis PA. Tuberculous meningitis in children: a review of 167 untreated and 74 treated patients with special reference to early diagnosis. J Pediatr 1960; 57: 807-823.
Yaramış A. Tekes S, Bilici M. Diagnostic performanceof amplifıed mycobacterium tuberculosis direct test in the cerebrospinal fluid of children with tuberculosis meningitis. Pediatrics 2000; 106: 102.
Schaller MA Wicke F Foerch C Weidauer S. Central Nervous System Tuberculosis. Clin Neuroradiol (2019) 29:3–18
Newton RW. Tuberculous meningitis. Arch Dis Child 1994; 70: 364-366.
Dastur DK, Manghani DK, Udani PM. Pathology and pathogenetic mechanisms in neurotuberculosis. Radiol Clin North Am 1995; 33: 733-752.
Berger JR. Tuberculous meningitis. Curr Opin Neurol 1994; 7: 191-200.
Leonard JM, Des Prez RM. Tuberculous meningitis. Infect Dis Clin North Am 1990; 4: 769-787.
Udani PM, Dastur DK. Tuberculous encephalopathy with and without meningitis. Clinical features and pathological correlations. J Neurol Sci 1970; 10: 541- 561.
Approach to childhood neurotuberculosis. IAP Textbook of Neurology. Rajeshwar Dayal, Madhu Singh: IAP National Publication House; 2019
Jerome H. Chin. Neurotuberculosis: A Clinical Review. Semin Neurol 2019;39:456–461.
Poon TL, WS Ho, Pang KY, Wong CK. Tuberculous meningitis with spinal tuberculous arachnoiditis. Hong Kong Med J. 2003;9:59–61.
Wadia NH, Dastur DK. Spinal meningitides with radiculo-myelopathy: Clinical and radiological features. J Neurol Sci. 1969;8:239–60.
Burton CV. Lumbosacral arachnoiditis. Spine. 1978;3:24–30.
Subhas K Konar, Kvl Narasinga Rao, Anita Mahadevan, B Indira Devi. Tuberculous lumbar arachnoiditis mimicking conus cauda tumor: A case report and review of literature Neurosci Rural Pract. 2011 Jan;2(1):93-6.
Bahr NC, Boulware DR. Methods of rapid diagnosis for the etiology of meningitis in adults. Biomark Med. 2014; 8(9): 1085–1103.
Bahr NC, Meintjes G, Boulware DR. Inadequate diagnostics: the case to move beyond the bacilli for detection of meningitis due to Mycobacterium tuberculosis. J Med Microbiol. 2019; 68(5): 755–760.
Bahr NC, Tugume L, Rajasingham R, et al. Improved diagnostic sensitivity for tuberculous meningitis with Xpert® MTB/RIF of centrifuged CSF. Int J Tuberc Lung Dis. 2015; 19(10): 1209–1215.
Bahr NC, Nuwagira E, Evans EE, et al. Diagnostic accuracy of Xpert MTB/RIF Ultra for tuberculous meningitis in HIV-infected adults: a prospective cohort study. Lancet Infect Dis. 2018; 18(1): 68–75.
Nhu NT, Heemskerk D, Thu do DA, et al. Evaluation of GeneXpert MTB/RIF for diagnosis of tuberculous meningitis. J Clin Microbiol. 2014; 52(1): 226–233.
Panicker JN, Nagaraja D, Subbakrishna DK, Venkataswamy MM, Chandramuki A (2010) Role of the BACTEC radiometric method in the evaluation of patients with clinically probable tuberculous meningitis. Ann Indian Acad Neurol 13(2):128–131.
Yaramış A, Bükte Y, Katar S, Ozbek MN. Chest computerized tomography scan findings in 74 children with tuberculous meningitis in southeastern Turkey. Turk J Pediatr. 2007 Oct-Dec;49(4):365-369.
Idriss ZH, Sinno AA, Kronfol NM. Tuberculous meningitis in childhood. Am J Dis Child 1976; 130: 364.
Zarabi M, Sane S, Girdany B. The chest roentgenogram in the early diagnosis of tuberculous meningitis in children. Am J Dis Child 1971; 121: 389.
Bernaerts A, Vanhoenacker FM, Parizel PM, et al. Tuberculosis of the central nervous system: overview of neuroradi- ological findings. Eur Radiol. 2003;13:1876–90.
Kumar R, Kohli N, Thavnani H, et al. Value of CT scan in the diagnosis of meningitis. Indian Pediatr. 1996;33(6):465-8.
M. Pienaar, S. Andronikou, and R. van Toorn. MRI to demonstrate diagnostic features and complications of TBM not seen with CT. Child's Nervous System. 2009; 25: 8: 941–947.
Pormohammad A, Nasiri MJ, McHugh TD, et al. A Systematic Review and Meta- analysis of the Diagnostic Accuracy of Nucleic Acid Amplification Tests for Tuberculous Meningitis. J Clin Microbiol. 2019; 57(6): pii: e01113-18.
Denkinger CM, Schumacher SG, Boehme CC, et al. Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta- analysis. Eur Respir J. 2014; 44(2): 435–446.
Automated Real-Time Nucleic Acid Amplification Technology for Rapid and Simultaneous Detection of Tuberculosis and Rifampicin Resistance: Xpert MTB/RIF Assay for the Diagnosis of Pulmonary and Extrapulmonary TB in Adults and Children: Policy Update. Geneva, 2013.
World Health Organization, Geneva, Switzerland: Global Tuberculosis Report 2014.
Wang G, Wang S, Jiang G, et al. Xpert MTB/RIF Ultra improved the diagnosis of paucibacillary tuberculosis: A prospective cohort study. J Infect. 2019; 78(4): 311–316.
Bahr NC, Marais S, Caws M, et al. GeneXpert MTB/Rif to Diagnose Tuberculous Meningitis: Perhaps the First Test but not the Last. Clin Infect Dis. 2016; 62(9): 1133–5.
Boyles TH, Thwaites GE. Appropriate use of the Xpert® MTB/RIF assay in suspected tuberculous meningitis. Int J Tuberc Lung Dis. 2015; 19(3): 276–277.
LaurentiP, RaponiM, deWaureC, et al. Performance of interferon-grelease assays in the diagnosis of confirmed active tuberculosis in immunocompetent children: a new systematic review and meta-analysis. BMC Infect Dis 2016; 16:131.
Rieder BL, Cauthen GM, Comstock GW, Snider DE. Epidemiology of tuberculosis in the United States. Epidemiol Rev. 1989;11:79–98
Beshir MR, Zidan AE, El-Saadny HF, et al. Evaluation of the immune response to interferon gamma release assay and tuberculin skin test among BCG Vaccinated Children in East of Egypt. Medicine 2016; 95:e3470.
WHO. Treatment of tuberculosis: guidelines – 4th ed. 2010. Avail- able at: http://www.who.int/tb/publications/2010/9789241547 833/en/. Accessed March 26, 2019
WHO. Guidance for national tuberculosis programmes on the management of tuberculosis in children – 2nd ed. 2014. Available at: http://www.who.int/tb/publications/childtb_guidelines/en/. Accessed March 26, 2019
WHO. Guidelines for treatment of drug-susceptible tuberculosis and patient care. 2017 Update. Available at: http://www.who.int/ tb/publications/2017/dstb_guidance_2017/en/. Accessed March 26, 2019.
Yaramis A, Colpan L, Tas MA. Diagnostic value of cytokine measurement in cerebrospinal fluid in children with central nervous system tuberculosis. Pediatrics. 2001 May;107(5):1236.
T.C. Sağlık Bakanlığı. Tüberküloz Tanı ve Tedavi Rehberi. ‘Çocuklarda TB tedavisi, sayfa 149’. 2. Baskı Ankara, Mayıs 2019 ISBN: 978-975-590-717-8.
WHO. Index-TB Guidelines. Guidelines on extra-pulmonary tuberculosis for India. Available at: https://tbcindia.gov.in/show- file.php?lid=3245. Accessed March 26, 2019.
Department of Health. Republic of South Africa. National Tuber- culosis Management Guidelines. 2014. Available at: https://www. health-e.org.za/wp-content/uploads/2014/06/NTCP_Adult_TB- Guidelines-27.5.2014.pdf. Accessed March 26, 2019.
Prasad K, Singh MB, Ryan H. Corticosteroids for managing tuber- culous meningitis. Cochrane Database Syst Rev 2016;4:CD002244.
The cerebrospinal fluid. In: Chusid JG, ed. Correlative Neuroanatomy and Functional Neurology. 18th ed. Lange, CA: 1982:229–232
World Health Organization (WHO). Global Tuberculosis Programme. WHO && treatment guidelines for drug-resistant tuberculosis: 2016 update; 2016. [Accessed 25 August 2017].
Update on trends in childhood tuberculosis. Fry S, Barnabas S, Cotton MF.Curr Opin Pediatr. 2018 Feb;30(1):152-160.
