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Tuberculosis, CNS

Tuberculosis, CNS is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • A granulomatous infection of the brain, meninges, or spinal cord caused by Mycobacterium tuberculosis
  • Central nervous system tuberculosis (CNS TB) includes tuberculous meningitis, intracranial or spinal tuberculoma, and spinal tuberculous arachnoiditis.

Epidemiology

Incidence
  • 2.8 cases of TB per 100,000 in United States
  • CNS TB accounts for 1% of all active TB cases but is more debilitating than other types of TB.

Prevalence
In 2017, 10 million cases of active TB with 1.3 million TB-related deaths worldwide (CDC)

Etiology and Pathophysiology

M. tuberculosis: History of TB is elicited in only 10% of infected adults.

  • Spreads hematogenously to the CNS, generally from a pulmonary focus
  • Small areas of infection (Rich foci) form in the brain parenchyma. Meningitis occurs when Rich foci rupture into subarachnoid space.

Genetics
Host factors that influence the risk of infection are polymorphisms associated with the LTA4H gene (1).

Risk Factors

  • Very young and very old, HIV infection, solid organ transplant patients, diabetics, patients on steroids or other immunosuppressive therapies
  • History of pulmonary TB or exposure to active TB
  • Malnutrition, recent measles (children), alcoholism, malignancy
  • Latent TB infection
  • Immigrants from TB-endemic areas

General Prevention

  • Direct-observed antituberculous therapy improves treatment success and minimizes drug resistance.
  • Neonatal and childhood bacillus Calmette-Guérin (BCG) vaccination in areas with high incidence of TB disease recommended to protect against TB meningitis (2)

Commonly Associated Conditions

HIV infection; alcohol abuse; malignancy

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Citation

Stephens, Mark B., et al., editors. "Tuberculosis, CNS." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816080/0/Tuberculosis_CNS.
Tuberculosis, CNS. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816080/0/Tuberculosis_CNS. Accessed August 21, 2019.
Tuberculosis, CNS. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816080/0/Tuberculosis_CNS
Tuberculosis, CNS [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 August 21]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816080/0/Tuberculosis_CNS.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Tuberculosis, CNS ID - 816080 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816080/0/Tuberculosis_CNS PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -