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Tuberculosis of the Central Nervous System pp 511–524Cite as

Management of Multidrug-Resistant Tuberculosis Involving the Nervous System

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Abstract

Tuberculosis (TB) is one of the most prevalent infections encountered in developing countries and, with the advent of immunosuppression and population migration, is being increasingly reported from developed countries. Children remain at a disproportionately high risk of central nervous system (CNS) TB. In the year 2010 alone, there were a total of 8,800,000 (range, 8,500,000–9,200,000) cases and 1,100,000 (range, 900,000–1,200,000) deaths from TB. TB of CNS is one of the most devastating forms of the disease with the greatest morbidity and mortality, although only about 5% of TB infections affect the CNS. The tubercle bacilli are aerobic and nonmotile with a slow doubling time and generally spread via an airborne mechanism. For CNS-TB to occur, there is a hematogenous spread to various regions of the body including the meninges. Anti-TB drugs including rifampicin (RIF) and isoniazid (INH) have been the mainstay of treatment, but in the last few years, there has been an increasing prevalence of new drug-resistant strains [multidrug resistant-tuberculosis (MDR-TB resistant to at least INH and RIF) or extremely drug resistant-tuberculosis (XDR-TB resistant to INH and RIF along with resistance to a fluoroquinolone and injectable second-line drugs)]. Globally, MDR-TB accounts for 3.4% of all new cases and 20% of all re-treatment cases. XDR-TB has been reported in 69 countries worldwide, and data indicates that 25,000 new cases of XDR-TB are being reported every year. This apart from increasing the mortality and morbidity of TB has also exponentially increased the cost of treatment, especially in countries that can least afford them. In this chapter we shall discuss the diagnosis and management of MDR-TB.

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Abbreviations

ART:

Antiretroviral therapy

CNS:

Central nervous system

CSF:

Cerebrospinal fluid

CT:

Computed tomography

DST:

Drug susceptibility testing

EMB:

Ethambutol

INH:

Isoniazid

MDR-TB:

Multidrug resistant-tuberculosis

PCR:

Polymerase chain reaction

PZA:

Pyrazinamide

RIF:

Rifampicin

TB:

Tuberculosis

TBA:

Tuberculous brain abscess

TBM:

Tuberculous meningitis

WHO:

World Health Organization

XDR-TB:

Extremely drug resistant-tuberculosis

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Authors and Affiliations

  1. Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India

    Dwarakanath Srinivas MS, MCh (Neurosurgery) & Pragyan Sarma MS, MCh

Authors
  1. Dwarakanath Srinivas MS, MCh (Neurosurgery)
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  2. Pragyan Sarma MS, MCh
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Corresponding author

Correspondence to Dwarakanath Srinivas MS, MCh (Neurosurgery) .

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

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Srinivas, D., Sarma, P. (2017). Management of Multidrug-Resistant Tuberculosis Involving the Nervous System. 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_36

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  • DOI: https://doi.org/10.1007/978-3-319-50712-5_36

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