Skip to main content
SpringerLink
Log in
Book cover

Tuberculosis of the Central Nervous System pp 391–399Cite as

Medical Therapy

  • Chapter
  • First Online:

Abstract

Central nervous system (CNS) tuberculosis (TB) includes tuberculous meningitis (TBM), intracranial tuberculomas, TB abscesses, and spinal TB arachnoiditis. TBM is the most common presentation. A high index of doubt is essential for timely diagnosis and therapy. Empiric anti-TB therapy should be initiated once clinical, laboratory, or imaging findings suspect CNS TB. Anti-TB therapy is advised for 9–12 months. Corticosteroid therapy for the first 8 weeks in patients with TBM has been associated with decreased mortality and fewer neurologic sequelae.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   199.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Abbreviations

CNS:

Central nervous system

CSF:

Cerebrospinal fluid

EMB:

Ethambutol

HIV:

Human immunodeficiency virus

INH:

Isoniazid

MDR:

Multidrug resistant

MIC:

Minimum inhibitor concentration

NICE:

National Institute for Health and Clinical Excellence

PAS:

Para-aminosalicylic acid

PN:

Peripheral neuropathy

PZA:

Pyrazinamide

RIF:

Rifampicin

STR:

Streptomycin

TB:

Tuberculosis

TBM:

Tuberculous meningitis

WHO:

World Health Organization

XDR:

Extensively drug resistant

References

  1. Cherian A, Thomas SV (2011) Central nervous system tuberculosis. Afr Health Sci 11:116–127

    CAS  PubMed  PubMed Central  Google Scholar 

  2. Golden MP, Vikram HR (2005) Extrapulmonary tuberculosis: an overview. Am Fam Physician 72:1761–1768

    PubMed  Google Scholar 

  3. Thwaites GE, Chau TT, Stepniewska K, Phu NH, Chuong LV, Sinh DX, White NJ, Parry CM, Farrar JJ (2002) Diagnosis of adult tuberculous meningitis by use of clinical and laboratory features. Lancet 360:1287–1292

    Article  CAS  PubMed  Google Scholar 

  4. Garg RK (1999) Tuberculosis of the central nervous system. Postgrad Med J 75:133–140

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Wiles CM (2005) The meningitis. In: Walton J (ed) Brain’s disease of the nervous system, Oxford, vol 4, pp 160–170

    Google Scholar 

  6. Zhang Y (2004) Isoniazid. In: Rom WN, Garay SM (eds) Tuberculosis, 2nd edn. Lippincott Williams & Wilkins, Philadelphia, pp 739–758

    Google Scholar 

  7. Iseman MD (2002) Tuberkuloz kemoterapisi, doğrudan gözetimli tedavi dahil. (in Turkish). In: Iseman MD (ed) Klinisyenler icin Tuberkuloz Kılavuzu (in Turkish) (trans: Özkara Ş). Nobel Tıp Kitabevleri, İstanbul, pp 271–321

    Google Scholar 

  8. Vernon AA (2004) Rifamycin antibiotics, with a focus on newer agents. In: Rom WN, Garay SM (eds) Tuberculosis, 2nd edn. Lippincott Williams & Wilkins, Philadelphia, pp 759–771

    Google Scholar 

  9. Telenti A, Imboden P, Marchesi F, Matter L, Schopfer K, Bodmer T, Lowrie D, Colston MJ, Cole S (1993) Detection of RIF-resistant mutations in Mycobacterium tuberculosis. Lancet 341:647–651

    Article  CAS  PubMed  Google Scholar 

  10. Girling DJ (1984) The role of pyrazinamide in primary chemotherapy for pulmonary tuberculosis. Tubercle 65:1–4

    Article  CAS  PubMed  Google Scholar 

  11. Heifets LB, Lindholm-Levy PJ (1990) Is pyrazinamide bactericidal against Mycobacterium tuberculosis? Am Rev Respir Dis 141:250–252

    Article  CAS  PubMed  Google Scholar 

  12. Conte JE, Golden JA, Duncan S, McKenna E, Zurlinden E (1999) Intrapulmonary concentrations of pyrazinamide. Antimicrob Agents Chemother 43:1329–1333

    CAS  PubMed  PubMed Central  Google Scholar 

  13. Ellard GA, Humphries MJ, Gabriel M, Teoh R (1987) Penetration of pyrazinamide into the cerebrospinal fluid in tuberculous meningitis. Br Med J 294:284–285

    Article  CAS  Google Scholar 

  14. Yakrus MA, Driscoll J, McAlister A, Sikes D, Hartline D, Metchock B, Starks AM (2016) Molecular and growth-based drug susceptibility testing of Mycobacterium tuberculosis complex for ethambutol resistance in the United States. Tuberc Res Treat 2016:3404860

    PubMed  PubMed Central  Google Scholar 

  15. American Thoracic Society/Centers for Disease Control and Prevention/ Infectious Diseases Society of America (2003) Treatment of tuberculosis. Am J Respir Crit Care Med 167:603–662

    Article  Google Scholar 

  16. Chan ED, Chatterjee D, Iseman MD, Heifets LB (2004) Pyrazinamide, ethambutol, ethionamide, and aminoglycosides. In: Rom WM, Garay SM (eds) Tuberculosis, 2nd edn. Lippincott Williams & Wilkins, Philadelphia, pp 773–789

    Google Scholar 

  17. Heifets LB, Lindholm-Levy PJ (1989) Comparison of bactericidal activities of streptomycin, amikacin, kanamycin, and capreomycin against M. avium and M. tuberculosis. Antimicrob Agents Chemother 33:1298–1301

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Nahid P, Dorman SE, Alipanah N, Barry PM, Brozek JL, Cattamanchi A, Chaisson LH, Chaisson RE, Daley CL, Grzemska M, Higashi JM, Ho CS, Hopewell PA, Keshavjee SA, Lienhardt C, Menzies R, Merrifield C, Narita M, O’brien R, Peloquin CA, Raftery A, Saukkonen J, Schaaf HS, Sotgiu G, Starke JR, Migliori GB, Vernon A (2016) Official American Thoracic Society/Centers for Disease Control and Prevention/ Infectious Diseases Society of America clinical practice guidelines: treatment of drug-susceptible tuberculosis. Clin Infect Dis 63(7):e147–e195. doi:10.1093/cid/ciw376

    Article  PubMed  Google Scholar 

  19. Moadebi S, Harder CK, Fitzgerald MJ, Elwood KR, Marra F (2007) Fluoroquinolones for the treatment of pulmonary tuberculosis. Drugs 67:2077–2099

    Article  CAS  PubMed  Google Scholar 

  20. World Health Organization (2016) WHO treatment guidelines for drug resistant tuberculosis, 2016 update. WHO/HTM/TB/2016.04

    Google Scholar 

  21. Mehlhorn AJ, Brown DA (2007) Safety concerns with fluoroquinolones. Ann Pharmacother 41:1859–1866

    Article  PubMed  Google Scholar 

  22. Donald PR, Gent WL, Seifart HI, Lamprecht JH, Parkin DP (1992) Cerebrospinal fluid isoniazid concentrations in children with tuberculous meningitis: the influence of dosage and acetylation status. Pediatrics 89:247–250

    CAS  PubMed  Google Scholar 

  23. Ellard GA, Humphries MJ, Allen BW (1993) Cerebrospinal fluid drug concentrations and the treatment of tuberculous meningitis. Am Rev Resp Dis 148:650–655

    Article  CAS  PubMed  Google Scholar 

  24. Thwaites GE, Lan NT, Dung NH, Quy HT, Oanh DT, Thoa NT, Hien NQ, Thuc NT, Hai NN, Bang ND, Lan NN, Duc NH, Tuan VN, Hiep CH, Chau TT, Mai PP, Dung NT, Stepniewska K, White NJ, Hien TT, Farrar JJ (2005) Effect of antituberculosis drug resistance on response to treatment and outcome in adults with tuberculous meningitis. J Infect Dis 192:79–88

    Article  PubMed  Google Scholar 

  25. Marx GE, Chan E (2011) Tuberculous meningitis: diagnosis and treatment overview. Tuberc Res Treat 2011:798764

    PubMed  PubMed Central  Google Scholar 

  26. World Health Organization (2010) Treatment of tuberculosis: guidelines, 4th edn. World Health Organization, Geneva WHO/HTM/TB/2009.420

    Google Scholar 

  27. National Institute for Health and Clinical Excellence (2011) Tuberculosis. NICE Clinical Guidelines, No. 117

    Google Scholar 

  28. Pickering LK, Baker CJ, Long SS, JA MM (2006) Tuberculosis. In: Red book: 2006 report of the Committee on Infectious Diseases, 27th edn. American Academy of Pediatrics, Elk Grove Village, pp 678–698

    Google Scholar 

  29. Fox W, Ellard GA, Mitchison DA (1993) Studies on the treatment of tuberculosis undertaken by the British Medical Research Council tuberculosis units, 1946–1986. Int J Tuberc Lung Dis 3(10 Suppl 2):231–279

    CAS  Google Scholar 

  30. Jindani A, Nunn AJ, Enarson DA (2004) Two 8 month regimens of chemotherapy for treatment of newly diagnosed pulmonary tuberculosis: international multicentre randomised trial. Lancet 364(9441):1244–1251

    Article  CAS  PubMed  Google Scholar 

  31. Snider DE Jr (1980) Pyridoxine supplementation during INH therapy. Tubercle 61:191–196

    Article  PubMed  Google Scholar 

  32. Hagan G, Nathani N (2013) Clinical review: tuberculosis on the intensive care unit. Crit Care 17:240

    Article  PubMed  PubMed Central  Google Scholar 

  33. Salpeter S (1993) Fatal INH-induced hepatitis: its risk during chemoprophylaxis. West J Med 159:560–564

    CAS  PubMed  PubMed Central  Google Scholar 

  34. Sanders WEJ (1976) Rifampin. Ann Intern Med 85:82–86

    Article  CAS  PubMed  Google Scholar 

  35. Saukkonen JJ, Cohn DL, Jasmer RM, Schenker S, Jereb JA, Nolan CM, Peloquin CA, Gordin FM, Nunes D, Strader DB, Bernardo J, Venkataramanan R, Sterling TR (2006) An official ATS statement: hepatotoxicity of antituberculosis therapy. Am J Respir Crit Care Med 174:935–952

    Article  CAS  PubMed  Google Scholar 

  36. Milburn H, Ashman N, Davies P, Doffman S, Drobniewski F, Khoo S, Ormerod P, Ostermann M, Snelson C (2010) Guidelines for the prevention and management of Mycobacterium tuberculosis infection and disease in adult patients with chronic kidney disease. Thorax 65:557–570

    Article  PubMed  Google Scholar 

  37. Thwaites G, Fisher M, Hemingway C, Scott G, Solomon T, Innes J (2009) British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children. J Infect 59:167–187

    Article  PubMed  Google Scholar 

  38. Thwaites GE, Nguyen DB, Nguyen HD, Hoang TQ, Do TT, Nguyen TC, Nguyen QH, Nguyen TT, Nguyen NH, Nguyen TN, Nguyen NL, Nguyen HD, Vu NT, Cao HH, Tran TH, Pham PM, Nguyen TD, Stepniewska K, White NG, Tran TH, Farrar JJ (2004) Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults. N Engl J Med 351:1741–1751

    Article  CAS  PubMed  Google Scholar 

  39. Sagonda T, Mupfumi L, Manzou R, Makamure B, Tshabalala M, Gwanzura L, Mason P, Mutetwa R (2014) Prevalence of extensively drug resistant tuberculosis among archived multidrug resistant tuberculosis isolates in Zimbabwe. Tuberc Res Treat 2014:349141

    PubMed  PubMed Central  Google Scholar 

  40. Wang YT, Chee CB, Hsu LY, Jagadesan R, Kaw GJ, Kong PM, Lew YJ, Lim CS, Lim TT, Lu KF, Ooi PL, Sng LH, Thoon KC (2016) Ministry of health clinical practice guidelines: prevention, diagnosis and management of tuberculosis. Singapore Med J 57(3):118–124

    Article  PubMed  PubMed Central  Google Scholar 

  41. Rock RB, Olin M, Baker CA, Molitor TW, Peterson PK (2008) Central nervous system tuberculosis: pathogenesis and clinical aspects. Clin Microbiol Rev 21:243–261

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Senbayrak S, Ozkutuk N, Erdem H, Johansen IS, Civljak R, Inal AS, Kayabas U, Kursun E, Elaldi N, Savic B, Simeon S, Yilmaz E, Dulovic O, Ozturk-Engin D, Ceran N, Lakatos B, Sipahi OR, Sunbul M, Yemisen M, Alabay S, Beovic B, Ulu-Kilic A, Cag Y, Catroux M, Inan A, Dragovac G, Deveci O, Tekin R, Gul HC, Sengoz G, Andre K, Harxhi A, Hansmann Y, Oncu S, Kose S, Oncul O, Parlak E, Sener A, Yilmaz G, Savasci U, Vahaboglu H (2015) Antituberculosis drug resistance patterns in adults with tuberculous meningitis: results of haydarpasa-iv study. Ann Clin Microbiol Antimicrob 14:47

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Chest Diseases, Adnan Menderes University School of Medicine, Aydın, Turkey

    Şule T. Gülen MD

  2. Department of Neurosurgery, Adnan Menderes University School of Medicine, Aydın, Turkey

    Mehmet Turgut MD, PhD

  3. Department of Infectious Diseases, Adnan Menderes University School of Medicine, Aydın, Turkey

    Güliz U. Güleç MD

  4. Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey

    Ahmet T. Turgut MD

  5. Department of Neurosurgery, Avicenne Military Hospital of Marrakech. Mohammed V University, Rabat, Morocco

    Ali Akhaddar MD, IFAANS

Authors
  1. Şule T. Gülen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mehmet Turgut MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Güliz U. Güleç MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ahmet T. Turgut MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ali Akhaddar MD, IFAANS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Şule T. Gülen MD .

Editor information

Editors and Affiliations

  1. Adnan Menderes University, School of Medicine, Aydın, Turkey

    Mehmet Turgut

  2. Mohammed V University in Rabat, Avicenne Military Hospital of Marrakech, Rabat, Morocco

    Ali Akhaddar

  3. Hacettepe University, School of Medicine, Ankara, Turkey

    Ahmet T. Turgut

  4. King George Medical University, Lucknow, Uttar Pradesh, India

    Ravindra K. Garg

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Gülen, Ş.T., Turgut, M., Güleç, G.U., Turgut, A.T., Akhaddar, A. (2017). Medical Therapy. In: Turgut, M., Akhaddar, A., Turgut, A., Garg, R. (eds) Tuberculosis of the Central Nervous System. Springer, Cham. https://doi.org/10.1007/978-3-319-50712-5_27

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-50712-5_27

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-50711-8

  • Online ISBN: 978-3-319-50712-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation