The Experts below are selected from a list of 255 Experts worldwide ranked by ideXlab platform
Ravindra Kumar Garg - One of the best experts on this subject based on the ideXlab platform.
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Management of complex tuberculosis cases: a focus on drug-resistant Tuberculous Meningitis.
Expert review of anti-infective therapy, 2018Co-Authors: Ravindra Kumar Garg, Hardeep Singh Malhotra, Ravi Uniyal, Imran Rizvi, Neeraj KumarAbstract:Drug-resistant Tuberculous Meningitis has been reported worldwide. Isoniazid mono-resistance is the most frequent cause of drug-resistant Tuberculous Meningitis, a life-threatening disease. Extensive drug-resistant Tuberculous Meningitis has also been reported in some isolated case reports. Areas covered: We reviewed the current literature on drug-resistant Tuberculous Meningitis, as well as drug-resistant tuberculosis. Expert commentary: Drug-resistant Tuberculous Meningitis is a life-threatening disease and needs prompt diagnosis and treatment. Xpert MTB/RIF Ultra technology can detect Mycobacterium tuberculosis and rifampicin resistance in cerebrospinal fluid (CSF) even with low numbers of bacilli. The optimum antituberculosis drug regimen for multidrug-resistant Tuberculous Meningitis is largely unknown as no second-line antituberculosis drug-containing regimen has been tested in a randomized controlled fashion in drug-resistant Tuberculous Meningitis. A combination of levofloxacin, kanamycin, ethionamide, linezolid, and pyrazinamide would be an appropriate regimen because of excellent CSF profile of most of these drugs. End TB Strategy will help in checking the increasing challenge of drug-resistant Tuberculous Meningitis as it aims to eliminate all kinds of tuberculosis by the year 2035.
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Vision loss in Tuberculous Meningitis
Journal of the neurological sciences, 2017Co-Authors: Ravindra Kumar Garg, Hardeep Singh Malhotra, Neeraj Kumar, Ravi UniyalAbstract:Vision loss is a disabling complication of Tuberculous Meningitis. Approximately, 15% of survivors are either completely or partially blind. All structures of the visual pathway may be affected in Tuberculous Meningitis. Optic nerve and optic chiasma are most frequently and dominantly affected. Thick-gelatinous exudates lying over the base of brain, are the pathological hallmark of Tuberculous Meningitis and are responsible for almost all of its major complications, including vision loss. Strangulation of optic nerves and optic chiasma by the exudates, compression over optic chiasma by the dilated third ventricle, raised intracranial pressure, endarteritis, shunt failure, bacterial invasion of optic nerves and drug-induced optic nerve damage are important reasons that are considered responsible for vision loss. Prompt antituberculosis treatment is the best management option available. Immunomodulatory drugs and cerebrospinal fluid diversion procedures are of limited help. Early recognition and treatment of Tuberculous Meningitis is the only way forward to tackle this problem.
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Neuroimaging in Tuberculous Meningitis.
Neurology India, 2016Co-Authors: Ravindra Kumar Garg, Hardeep Singh Malhotra, Amita JainAbstract:Tuberculous Meningitis is a serious infection caused by Mycobacterium tuberculosis. Early diagnosis is the key to success of treatment. Neuroimaging plays a crucial role in the early and accurate diagnosis of Tuberculous Meningitis and its disabling complications. Magnetic resonance imaging is considered superior to computed tomography. Neuroimaging characteristics include leptomeningeal and basal cisternal enhancement, hydrocephalus, periventricular infarcts, and tuberculoma. Partially treated pyogenic Meningitis, cryptococcal Meningitis, viral encephalitis, carcinomatous, and lymphomatous Meningitis may have many similar neuroimaging characteristics, and differentiation from Tuberculous Meningitis at times on the basis of neuroimaging characteristics becomes difficult.
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Hydrocephalus in Tuberculous Meningitis: Incidence, its predictive factors and impact on the prognosis.
The Journal of infection, 2013Co-Authors: Tushar Premraj Raut, Ravindra Kumar Garg, Hardeep Singh Malhotra, Amita Jain, Neera Kohli, Maneesh Kumar Singh, Rajesh Verma, Anit PariharAbstract:Summary Background Hydrocephalus is one of the most common complications of Tuberculous Meningitis. The present study evaluated the incidence, predictive factors and impact of hydrocephalus on overall prognosis of Tuberculous Meningitis. Material and methods In a prospective cohort study, all patients fulfilling the inclusion criteria of Tuberculous Meningitis underwent clinical and cerebrospinal fluid evaluation, together with magnetic resonance imaging of the brain. Patients were treated with antituberculosis drugs and dexamethasone. Follow up neuroimaging was done after 6 months. Hydrocephalus was assessed using Evan's index. Results Of 80 patients with Tuberculous Meningitis, 52(65%) had hydrocephalus at presentation. During follow up, 8 new patients developed hydrocephalus. Factors associated with hydrocephalus included advanced stage of disease, severe disability, duration of illness > 2 months, diplopia, seizures, visual impairment, papilledema, cranial nerve palsy, hemiparesis, CSF total cell count > 100/cu.mm, CSF protein > 2.5 g/l. Neuroimaging factors that were significantly associated with hydrocephalus included basal exudates, tuberculoma and infarcts. Multivariate analysis revealed visual impairment, cranial nerve palsy and the presence of basal exudates as significant predictors of hydrocephalus. In 13 patients, with early Tuberculous Meningitis, there was complete resolution of hydrocephalus. Hydrocephalus was significantly associated with mortality and poor outcome. Conclusion Hydrocephalus occurs in approximately two-third of patients with Tuberculous Meningitis and has an unfavorable impact on the prognosis. Hydrocephalus in early stages of Tuberculous Meningitis may resolve completely.
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Drug-resistant Tuberculous Meningitis.
Expert review of anti-infective therapy, 2013Co-Authors: Ravindra Kumar Garg, Hardeep Singh Malhotra, Amita Jain, Avinash Agrawal, Rajiv GargAbstract:Drug-resistant tuberculosis, including drug-resistant Tuberculous Meningitis, is an emerging health problem in many countries. An association with Beijing strains and drug resistance-related mutations, such as mutations in katG and rpoB genes, has been found. The pathology, clinical features and neuroimaging characteristics of drug-resistant Tuberculous Meningitis are similar to drug-responsive Tuberculous Meningitis. Detection of mycobacteria in cerebrospinal fluid (CSF) by conventional methods (smear examination or culture) is often difficult. Nucleic acid amplification assays are better methods owing to their rapidity and high sensitivity. The Xpert MTB/RIF assay (Cepheid, CA, USA) is a fully-automated test that has also been found to be effective for CSF samples. Treatment of multidrug-resistant Tuberculous Meningitis depends on the drug susceptibility pattern of the isolate and/or the previous treatment history of the patient. Second-line drugs with good penetration of the CSF should be preferred. Isoniazid monoresistant disease requires addition of another drug with better CSF penetration. Drug-resistant Tuberculous Meningitis is associated with a high mortality. HIV infected patients with drug-resistant Tuberculous Meningitis have severe clinical manifestations with exceptionally high mortality. Prevention of tuberculosis is the key to reduce drug-resistant Tuberculous Meningitis.
Hardeep Singh Malhotra - One of the best experts on this subject based on the ideXlab platform.
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Management of complex tuberculosis cases: a focus on drug-resistant Tuberculous Meningitis.
Expert review of anti-infective therapy, 2018Co-Authors: Ravindra Kumar Garg, Hardeep Singh Malhotra, Ravi Uniyal, Imran Rizvi, Neeraj KumarAbstract:Drug-resistant Tuberculous Meningitis has been reported worldwide. Isoniazid mono-resistance is the most frequent cause of drug-resistant Tuberculous Meningitis, a life-threatening disease. Extensive drug-resistant Tuberculous Meningitis has also been reported in some isolated case reports. Areas covered: We reviewed the current literature on drug-resistant Tuberculous Meningitis, as well as drug-resistant tuberculosis. Expert commentary: Drug-resistant Tuberculous Meningitis is a life-threatening disease and needs prompt diagnosis and treatment. Xpert MTB/RIF Ultra technology can detect Mycobacterium tuberculosis and rifampicin resistance in cerebrospinal fluid (CSF) even with low numbers of bacilli. The optimum antituberculosis drug regimen for multidrug-resistant Tuberculous Meningitis is largely unknown as no second-line antituberculosis drug-containing regimen has been tested in a randomized controlled fashion in drug-resistant Tuberculous Meningitis. A combination of levofloxacin, kanamycin, ethionamide, linezolid, and pyrazinamide would be an appropriate regimen because of excellent CSF profile of most of these drugs. End TB Strategy will help in checking the increasing challenge of drug-resistant Tuberculous Meningitis as it aims to eliminate all kinds of tuberculosis by the year 2035.
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Vision loss in Tuberculous Meningitis
Journal of the neurological sciences, 2017Co-Authors: Ravindra Kumar Garg, Hardeep Singh Malhotra, Neeraj Kumar, Ravi UniyalAbstract:Vision loss is a disabling complication of Tuberculous Meningitis. Approximately, 15% of survivors are either completely or partially blind. All structures of the visual pathway may be affected in Tuberculous Meningitis. Optic nerve and optic chiasma are most frequently and dominantly affected. Thick-gelatinous exudates lying over the base of brain, are the pathological hallmark of Tuberculous Meningitis and are responsible for almost all of its major complications, including vision loss. Strangulation of optic nerves and optic chiasma by the exudates, compression over optic chiasma by the dilated third ventricle, raised intracranial pressure, endarteritis, shunt failure, bacterial invasion of optic nerves and drug-induced optic nerve damage are important reasons that are considered responsible for vision loss. Prompt antituberculosis treatment is the best management option available. Immunomodulatory drugs and cerebrospinal fluid diversion procedures are of limited help. Early recognition and treatment of Tuberculous Meningitis is the only way forward to tackle this problem.
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Neuroimaging in Tuberculous Meningitis.
Neurology India, 2016Co-Authors: Ravindra Kumar Garg, Hardeep Singh Malhotra, Amita JainAbstract:Tuberculous Meningitis is a serious infection caused by Mycobacterium tuberculosis. Early diagnosis is the key to success of treatment. Neuroimaging plays a crucial role in the early and accurate diagnosis of Tuberculous Meningitis and its disabling complications. Magnetic resonance imaging is considered superior to computed tomography. Neuroimaging characteristics include leptomeningeal and basal cisternal enhancement, hydrocephalus, periventricular infarcts, and tuberculoma. Partially treated pyogenic Meningitis, cryptococcal Meningitis, viral encephalitis, carcinomatous, and lymphomatous Meningitis may have many similar neuroimaging characteristics, and differentiation from Tuberculous Meningitis at times on the basis of neuroimaging characteristics becomes difficult.
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Hydrocephalus in Tuberculous Meningitis: Incidence, its predictive factors and impact on the prognosis.
The Journal of infection, 2013Co-Authors: Tushar Premraj Raut, Ravindra Kumar Garg, Hardeep Singh Malhotra, Amita Jain, Neera Kohli, Maneesh Kumar Singh, Rajesh Verma, Anit PariharAbstract:Summary Background Hydrocephalus is one of the most common complications of Tuberculous Meningitis. The present study evaluated the incidence, predictive factors and impact of hydrocephalus on overall prognosis of Tuberculous Meningitis. Material and methods In a prospective cohort study, all patients fulfilling the inclusion criteria of Tuberculous Meningitis underwent clinical and cerebrospinal fluid evaluation, together with magnetic resonance imaging of the brain. Patients were treated with antituberculosis drugs and dexamethasone. Follow up neuroimaging was done after 6 months. Hydrocephalus was assessed using Evan's index. Results Of 80 patients with Tuberculous Meningitis, 52(65%) had hydrocephalus at presentation. During follow up, 8 new patients developed hydrocephalus. Factors associated with hydrocephalus included advanced stage of disease, severe disability, duration of illness > 2 months, diplopia, seizures, visual impairment, papilledema, cranial nerve palsy, hemiparesis, CSF total cell count > 100/cu.mm, CSF protein > 2.5 g/l. Neuroimaging factors that were significantly associated with hydrocephalus included basal exudates, tuberculoma and infarcts. Multivariate analysis revealed visual impairment, cranial nerve palsy and the presence of basal exudates as significant predictors of hydrocephalus. In 13 patients, with early Tuberculous Meningitis, there was complete resolution of hydrocephalus. Hydrocephalus was significantly associated with mortality and poor outcome. Conclusion Hydrocephalus occurs in approximately two-third of patients with Tuberculous Meningitis and has an unfavorable impact on the prognosis. Hydrocephalus in early stages of Tuberculous Meningitis may resolve completely.
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Drug-resistant Tuberculous Meningitis.
Expert review of anti-infective therapy, 2013Co-Authors: Ravindra Kumar Garg, Hardeep Singh Malhotra, Amita Jain, Avinash Agrawal, Rajiv GargAbstract:Drug-resistant tuberculosis, including drug-resistant Tuberculous Meningitis, is an emerging health problem in many countries. An association with Beijing strains and drug resistance-related mutations, such as mutations in katG and rpoB genes, has been found. The pathology, clinical features and neuroimaging characteristics of drug-resistant Tuberculous Meningitis are similar to drug-responsive Tuberculous Meningitis. Detection of mycobacteria in cerebrospinal fluid (CSF) by conventional methods (smear examination or culture) is often difficult. Nucleic acid amplification assays are better methods owing to their rapidity and high sensitivity. The Xpert MTB/RIF assay (Cepheid, CA, USA) is a fully-automated test that has also been found to be effective for CSF samples. Treatment of multidrug-resistant Tuberculous Meningitis depends on the drug susceptibility pattern of the isolate and/or the previous treatment history of the patient. Second-line drugs with good penetration of the CSF should be preferred. Isoniazid monoresistant disease requires addition of another drug with better CSF penetration. Drug-resistant Tuberculous Meningitis is associated with a high mortality. HIV infected patients with drug-resistant Tuberculous Meningitis have severe clinical manifestations with exceptionally high mortality. Prevention of tuberculosis is the key to reduce drug-resistant Tuberculous Meningitis.
Neeraj Kumar - One of the best experts on this subject based on the ideXlab platform.
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Management of complex tuberculosis cases: a focus on drug-resistant Tuberculous Meningitis.
Expert review of anti-infective therapy, 2018Co-Authors: Ravindra Kumar Garg, Hardeep Singh Malhotra, Ravi Uniyal, Imran Rizvi, Neeraj KumarAbstract:Drug-resistant Tuberculous Meningitis has been reported worldwide. Isoniazid mono-resistance is the most frequent cause of drug-resistant Tuberculous Meningitis, a life-threatening disease. Extensive drug-resistant Tuberculous Meningitis has also been reported in some isolated case reports. Areas covered: We reviewed the current literature on drug-resistant Tuberculous Meningitis, as well as drug-resistant tuberculosis. Expert commentary: Drug-resistant Tuberculous Meningitis is a life-threatening disease and needs prompt diagnosis and treatment. Xpert MTB/RIF Ultra technology can detect Mycobacterium tuberculosis and rifampicin resistance in cerebrospinal fluid (CSF) even with low numbers of bacilli. The optimum antituberculosis drug regimen for multidrug-resistant Tuberculous Meningitis is largely unknown as no second-line antituberculosis drug-containing regimen has been tested in a randomized controlled fashion in drug-resistant Tuberculous Meningitis. A combination of levofloxacin, kanamycin, ethionamide, linezolid, and pyrazinamide would be an appropriate regimen because of excellent CSF profile of most of these drugs. End TB Strategy will help in checking the increasing challenge of drug-resistant Tuberculous Meningitis as it aims to eliminate all kinds of tuberculosis by the year 2035.
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Vision loss in Tuberculous Meningitis
Journal of the neurological sciences, 2017Co-Authors: Ravindra Kumar Garg, Hardeep Singh Malhotra, Neeraj Kumar, Ravi UniyalAbstract:Vision loss is a disabling complication of Tuberculous Meningitis. Approximately, 15% of survivors are either completely or partially blind. All structures of the visual pathway may be affected in Tuberculous Meningitis. Optic nerve and optic chiasma are most frequently and dominantly affected. Thick-gelatinous exudates lying over the base of brain, are the pathological hallmark of Tuberculous Meningitis and are responsible for almost all of its major complications, including vision loss. Strangulation of optic nerves and optic chiasma by the exudates, compression over optic chiasma by the dilated third ventricle, raised intracranial pressure, endarteritis, shunt failure, bacterial invasion of optic nerves and drug-induced optic nerve damage are important reasons that are considered responsible for vision loss. Prompt antituberculosis treatment is the best management option available. Immunomodulatory drugs and cerebrospinal fluid diversion procedures are of limited help. Early recognition and treatment of Tuberculous Meningitis is the only way forward to tackle this problem.
Sudha Rajagopalan - One of the best experts on this subject based on the ideXlab platform.
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Quantitative proteomics for identifying biomarkers for Tuberculous Meningitis
Clinical Proteomics, 2012Co-Authors: Ghantasala S Sameer Kumar, H C Harsha, Abhilash K Venugopal, Santosh Renuse, Nandini A. Sahasrabuddhe, Anita Mahadevan, Harsh Pawar, Praveen Kumar, Rakesh Sharma, Sudha RajagopalanAbstract:Introduction Tuberculous Meningitis is a frequent extrapulmonary disease caused by Mycobacterium tuberculosis and is associated with high mortality rates and severe neurological sequelae. In an earlier study employing DNA microarrays, we had identified genes that were differentially expressed at the transcript level in human brain tissue from cases of Tuberculous Meningitis. In the current study, we used a quantitative proteomics approach to discover protein biomarkers for Tuberculous Meningitis. Methods To compare brain tissues from confirmed cased of Tuberculous Meningitis with uninfected brain tissue, we carried out quantitative protein expression profiling using iTRAQ labeling and LC-MS/MS analysis of SCX fractionated peptides on Agilent’s accurate mass QTOF mass spectrometer. Results and conclusions Through this approach, we identified both known and novel differentially regulated molecules. Those described previously included signal-regulatory protein alpha (SIRPA) and protein disulfide isomerase family A, member 6 (PDIA6), which have been shown to be overexpressed at the mRNA level in Tuberculous Meningitis. The novel overexpressed proteins identified in our study included amphiphysin (AMPH) and neurofascin (NFASC) while ferritin light chain (FTL) was found to be downregulated in TBM. We validated amphiphysin, neurofascin and ferritin light chain using immunohistochemistry which confirmed their differential expression in Tuberculous Meningitis. Overall, our data provides insights into the host response in Tuberculous Meningitis at the molecular level in addition to providing candidate diagnostic biomarkers for Tuberculous Meningitis.
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Quantitative proteomics for identifying biomarkers for Tuberculous Meningitis
Clinical proteomics, 2012Co-Authors: Ghantasala S Sameer Kumar, H C Harsha, Abhilash K Venugopal, Santosh Renuse, Nandini A. Sahasrabuddhe, Anita Mahadevan, Harsh Pawar, Praveen Kumar, Rakesh Sharma, Sudha RajagopalanAbstract:Tuberculous Meningitis is a frequent extrapulmonary disease caused by Mycobacterium tuberculosis and is associated with high mortality rates and severe neurological sequelae. In an earlier study employing DNA microarrays, we had identified genes that were differentially expressed at the transcript level in human brain tissue from cases of Tuberculous Meningitis. In the current study, we used a quantitative proteomics approach to discover protein biomarkers for Tuberculous Meningitis. To compare brain tissues from confirmed cased of Tuberculous Meningitis with uninfected brain tissue, we carried out quantitative protein expression profiling using iTRAQ labeling and LC-MS/MS analysis of SCX fractionated peptides on Agilent’s accurate mass QTOF mass spectrometer. Through this approach, we identified both known and novel differentially regulated molecules. Those described previously included signal-regulatory protein alpha (SIRPA) and protein disulfide isomerase family A, member 6 (PDIA6), which have been shown to be overexpressed at the mRNA level in Tuberculous Meningitis. The novel overexpressed proteins identified in our study included amphiphysin (AMPH) and neurofascin (NFASC) while ferritin light chain (FTL) was found to be downregulated in TBM. We validated amphiphysin, neurofascin and ferritin light chain using immunohistochemistry which confirmed their differential expression in Tuberculous Meningitis. Overall, our data provides insights into the host response in Tuberculous Meningitis at the molecular level in addition to providing candidate diagnostic biomarkers for Tuberculous Meningitis.
Amita Jain - One of the best experts on this subject based on the ideXlab platform.
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Neuroimaging in Tuberculous Meningitis.
Neurology India, 2016Co-Authors: Ravindra Kumar Garg, Hardeep Singh Malhotra, Amita JainAbstract:Tuberculous Meningitis is a serious infection caused by Mycobacterium tuberculosis. Early diagnosis is the key to success of treatment. Neuroimaging plays a crucial role in the early and accurate diagnosis of Tuberculous Meningitis and its disabling complications. Magnetic resonance imaging is considered superior to computed tomography. Neuroimaging characteristics include leptomeningeal and basal cisternal enhancement, hydrocephalus, periventricular infarcts, and tuberculoma. Partially treated pyogenic Meningitis, cryptococcal Meningitis, viral encephalitis, carcinomatous, and lymphomatous Meningitis may have many similar neuroimaging characteristics, and differentiation from Tuberculous Meningitis at times on the basis of neuroimaging characteristics becomes difficult.
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Hydrocephalus in Tuberculous Meningitis: Incidence, its predictive factors and impact on the prognosis.
The Journal of infection, 2013Co-Authors: Tushar Premraj Raut, Ravindra Kumar Garg, Hardeep Singh Malhotra, Amita Jain, Neera Kohli, Maneesh Kumar Singh, Rajesh Verma, Anit PariharAbstract:Summary Background Hydrocephalus is one of the most common complications of Tuberculous Meningitis. The present study evaluated the incidence, predictive factors and impact of hydrocephalus on overall prognosis of Tuberculous Meningitis. Material and methods In a prospective cohort study, all patients fulfilling the inclusion criteria of Tuberculous Meningitis underwent clinical and cerebrospinal fluid evaluation, together with magnetic resonance imaging of the brain. Patients were treated with antituberculosis drugs and dexamethasone. Follow up neuroimaging was done after 6 months. Hydrocephalus was assessed using Evan's index. Results Of 80 patients with Tuberculous Meningitis, 52(65%) had hydrocephalus at presentation. During follow up, 8 new patients developed hydrocephalus. Factors associated with hydrocephalus included advanced stage of disease, severe disability, duration of illness > 2 months, diplopia, seizures, visual impairment, papilledema, cranial nerve palsy, hemiparesis, CSF total cell count > 100/cu.mm, CSF protein > 2.5 g/l. Neuroimaging factors that were significantly associated with hydrocephalus included basal exudates, tuberculoma and infarcts. Multivariate analysis revealed visual impairment, cranial nerve palsy and the presence of basal exudates as significant predictors of hydrocephalus. In 13 patients, with early Tuberculous Meningitis, there was complete resolution of hydrocephalus. Hydrocephalus was significantly associated with mortality and poor outcome. Conclusion Hydrocephalus occurs in approximately two-third of patients with Tuberculous Meningitis and has an unfavorable impact on the prognosis. Hydrocephalus in early stages of Tuberculous Meningitis may resolve completely.
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Drug-resistant Tuberculous Meningitis.
Expert review of anti-infective therapy, 2013Co-Authors: Ravindra Kumar Garg, Hardeep Singh Malhotra, Amita Jain, Avinash Agrawal, Rajiv GargAbstract:Drug-resistant tuberculosis, including drug-resistant Tuberculous Meningitis, is an emerging health problem in many countries. An association with Beijing strains and drug resistance-related mutations, such as mutations in katG and rpoB genes, has been found. The pathology, clinical features and neuroimaging characteristics of drug-resistant Tuberculous Meningitis are similar to drug-responsive Tuberculous Meningitis. Detection of mycobacteria in cerebrospinal fluid (CSF) by conventional methods (smear examination or culture) is often difficult. Nucleic acid amplification assays are better methods owing to their rapidity and high sensitivity. The Xpert MTB/RIF assay (Cepheid, CA, USA) is a fully-automated test that has also been found to be effective for CSF samples. Treatment of multidrug-resistant Tuberculous Meningitis depends on the drug susceptibility pattern of the isolate and/or the previous treatment history of the patient. Second-line drugs with good penetration of the CSF should be preferred. Isoniazid monoresistant disease requires addition of another drug with better CSF penetration. Drug-resistant Tuberculous Meningitis is associated with a high mortality. HIV infected patients with drug-resistant Tuberculous Meningitis have severe clinical manifestations with exceptionally high mortality. Prevention of tuberculosis is the key to reduce drug-resistant Tuberculous Meningitis.
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An unusual cause of visual impairment in Tuberculous Meningitis.
Journal of the neurological sciences, 2012Co-Authors: Hardeep Singh Malhotra, Ravindra Kumar Garg, Arvind Gupta, Sandeep Saxena, Aloy Majumdar, Amita JainAbstract:Impairment of vision is a devastating complication of Tuberculous Meningitis which may occur as a result of increased intracranial pressure, compression over the visual pathways or vasculitis. We herein present occurrence of neuroretinitis in a 35-year-old lady presenting with low grade fever and headache for one month, and associated with diminution of vision from 3 weeks. She was diagnosed as a case of definite Tuberculous Meningitis and initiated on anti-Tuberculous treatment as per WHO guidelines with supplemental corticosteroids. Marked improvement in vision was observed and at 3 months of follow-up the patient was asymptomatic. Direct ophthalmoscopy, visual field analysis, fluorescein angiography, optical coherence tomography and magnetic resonance imaging of the brain were done to document the ophthalmological findings. Neuroretinitis, being an unusual cause of visual impairment in Tuberculous Meningitis, must be considered in patients without any evidence of raised intracranial pressure or compression, and with normal fluorescein angiography. We suggest that neuroretinitis may be added to list of causes of visual impairment in patients with Tuberculous Meningitis.
