Tuberculosis

Abstract

Tuberculosis remains a serious health problem worldwide, particularly affecting the poorest in both high-income and developing countries. It was declared a global emergency by the World Health Organization in 1993. Central nervous system (CNS) tuberculosis is caused by mycobacteria belonging to the Mycobacterium tuberculosis complex, and is acquired through inhalation of aerosolized droplet nuclei. Meningitis represents the most frequent and severe form of CNS tuberculosis. Parenchymal CNS involvement can occur in the form of tuberculoma or, more rarely, abscess. Also, damage of the spinal cord, roots, and spine can occur in the form of spinal meningitis, radiculomyelitis, spondylitis, or spinal cord infarction. Diagnosis remains a challenge due to the slow growth of the organisms and the low yield of cerebrospinal fluid cultures, as well as the frequent absence of evidence of infection elsewhere. This results in frequent empirical therapy, based on a combination of four drugs (isoniazid, rifampicin, pyrazinamide and ethambutol) for 2 months, followed by 10 additional months with two drugs (isoniazid and rifampicin) to a total duration of 12 months. Shorter regimens have also been successful, but there have been few controlled trials in patients with extrapulmonary disease. Corticoid therapy seems to be associated with a reduced risk of death, and is usually indicated. Evidence of multidrug resistance requires variable combinations of first- and second-line drugs; fortunately, resistance does not seem to represent a serious threat for CNS tuberculosis at present, but still requires the utmost vigilance.

Keywords: Mycobacterium tuberculosis; Tuberculosis; tuberculoma; tuberculous abscess; tuberculous meningitis.