Journal ArticleDOI
Tuberculous meningitis: more questions, still too few answers
TLDR
Advances are insufficient in the face of drug-resistant tuberculosis and HIV co-infection, and there are still too few answers.Abstract:
Tuberculous meningitis is especially common in young children and people with untreated HIV infection, and it kills or disables roughly half of everyone affected. Childhood disease can be prevented by vaccination and by giving prophylactic isoniazid to children exposed to infectious adults, although improvements in worldwide tuberculosis control would lead to more effective prevention. Diagnosis is difficult because clinical features are non-specific and laboratory tests are insensitive, and treatment delay is the strongest risk factor for death. Large doses of rifampicin and fluoroquinolones might improve outcome, and the beneficial effect of adjunctive corticosteroids on survival might be augmented by aspirin and could be predicted by screening for a polymorphism in LTA4H, which encodes an enzyme involved in eicosanoid synthesis. However, these advances are insufficient in the face of drug-resistant tuberculosis and HIV co-infection. Many questions remain about the best approaches to prevent, diagnose, and treat tuberculous meningitis, and there are still too few answers.read more
Citations
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Journal ArticleDOI
Corticosteroids for managing tuberculous meningitis
TL;DR: Coricosteroids reduce mortality from tuberculous meningitis, at least in the short term, and this small possible harm is unlikely to be quantitatively important when compared to the reduction in mortality.
Journal ArticleDOI
Tuberculosis in children.
TL;DR: The result is a readable book, well illustrated and simple but comprehensive and authorita tive, the weakest part is that on cardiac surgery, but this is understandable, since rapid developments had out distanced the written account by the time the book had been printed and published.
Journal ArticleDOI
Diagnosis and Treatment of Extrapulmonary Tuberculosis
TL;DR: Although the disease usually responds to standard anti-TB drug therapy, the ideal regimen and duration of treatment have not yet been established and a paradoxical response frequently occurs during anti- TB therapy.
Extrapulmonary tuberculosis: an overview
TL;DR: Treatment for these types of tuberculosis does not differ from treatment regimens for pulmonary forms of the same disease, and any extension of this period is advisable solely in tuberculosis affecting the central nervous system and in Pott’s disease.
Journal ArticleDOI
Pathogens Penetrating the Central Nervous System: Infection Pathways and the Cellular and Molecular Mechanisms of Invasion
Samantha J. Dando,Alan Mackay-Sim,Robert Norton,Bart J. Currie,James Anthony St John,Jenny Ekberg,Jenny Ekberg,Michael R. Batzloff,Glen C. Ulett,Ifor R. Beacham +9 more
TL;DR: Recent data regarding mechanisms of bacterial translocation from the nasal mucosa to the brain are focused on, which represents a little explored pathway of bacterial invasion but has been proposed as being particularly important in explaining how infection with Burkholderia pseudomallei can result in melioidosis encephalomyelitis.
References
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Journal ArticleDOI
Effect of BCG vaccination on childhood tuberculous meningitis and miliary tuberculosis worldwide: a meta-analysis and assessment of cost-effectiveness
TL;DR: BCG vaccination is a highly cost-effective intervention against severe childhood tuberculosis; it should be retained in high-incidence countries as a strategy to supplement the chemotherapy of active tuberculosis.
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Tuberculosis. Clinical diagnosis and management of tuberculosis and measures for its prevention and control
Journal ArticleDOI
TNF Dually Mediates Resistance and Susceptibility to Mycobacteria via Mitochondrial Reactive Oxygen Species
TL;DR: Using the zebrafish, the cyclophilin D-inhibiting drug alisporivir and the acid sphingomyelinase-inactivating drug, desipramine, synergize to reverse susceptibility, suggesting the therapeutic potential of these orally active drugs against tuberculosis and possibly other TNF-mediated diseases.
Journal ArticleDOI
Host Genotype-Specific Therapies Can Optimize the Inflammatory Response to Mycobacterial Infections
David M. Tobin,Francisco J. Roca,Sungwhan F. Oh,Ross McFarland,Thad Vickery,John P. Ray,Dennis C. Ko,Yuxia Zou,Nguyen Duc Bang,Tran Thi Hong Chau,Jay C. Vary,Thomas R. Hawn,Sarah J. Dunstan,Jeremy Farrar,Guy E. Thwaites,Mary Claire King,Charles N. Serhan,Lalita Ramakrishnan +17 more
TL;DR: It is suggested that host-directed therapies tailored to patient LTA4H genotypes may counter detrimental effects of either extreme of inflammation, and therapies that specifically target each of these extremes are identified.