Abstract：
BACKGROUND: Wallgren\'s tuberculosis (TB) timetable demonstrated co-occurrence of miliary TB and tuberculous meningitis in children. To verify the same in immunocompetent adults, we prospectively evaluated the prevalence and spectrum of central nervous system (CNS) involvement in patients with pulmonary miliary TB.
METHODS: This was a tertiary care, University hospital-based, prospective evaluation performed from December 2018 to June 2020. Newly diagnosed patients with pulmonary miliary TB were subjected to a detailed clinical, laboratory and MRI-based evaluation. All patients received treatment as per WHO guidelines.
RESULTS: Out of 342 patients with pulmonary TB, 53 patients met the eligibility criteria. The median age at presentation was 32 y and approximately two-thirds of patients were female. Clinically, only two-fifths of patients had features of CNS involvement. Cerebrospinal fluid (CSF) and imaging abnormalities were noted in 46 patients each. Twelve (23.5%) patients were diagnosed with definite-category tuberculous meningitis. Presence of an infarct significantly correlated with neurological features. Mantoux positivity correlated significantly with the presence of choroid tubercles, CSF changes and brain tuberculomas.
CONCLUSIONS: This is the first study to endorse Wallgren\'s observations in immunocompetent adults. A high index of suspicion, even in asymptomatic patients, may uncover tuberculous lesions involving the CNS and guide optimal monitoring of patients.
METHODS: This was a tertiary care, University hospital-based, prospective evaluation performed from December 2018 to June 2020. Newly diagnosed patients with pulmonary miliary TB were subjected to a detailed clinical, laboratory and MRI-based evaluation. All patients received treatment as per WHO guidelines.
RESULTS: Out of 342 patients with pulmonary TB, 53 patients met the eligibility criteria. The median age at presentation was 32 y and approximately two-thirds of patients were female. Clinically, only two-fifths of patients had features of CNS involvement. Cerebrospinal fluid (CSF) and imaging abnormalities were noted in 46 patients each. Twelve (23.5%) patients were diagnosed with definite-category tuberculous meningitis. Presence of an infarct significantly correlated with neurological features. Mantoux positivity correlated significantly with the presence of choroid tubercles, CSF changes and brain tuberculomas.
CONCLUSIONS: This is the first study to endorse Wallgren\'s observations in immunocompetent adults. A high index of suspicion, even in asymptomatic patients, may uncover tuberculous lesions involving the CNS and guide optimal monitoring of patients.
摘要：
背景：Wallgren的结核病（TB）时间表显示，儿童中同时发生的是粟粒性结核病和结核性脑膜炎。为了在有免疫能力的成年人中验证相同，我们前瞻性地评估了肺结核患者中枢神经系统(CNS)受累的患病率和范围.
方法：这是三级护理，大学医院，前瞻性评估于2018年12月至2020年6月进行。新诊断的肺结核患者进行了详细的临床，实验室和基于MRI的评估。所有患者均按照WHO指南接受治疗。
结果：在342例肺结核患者中，53名患者符合资格标准。就诊时的中位年龄为32岁，约三分之二的患者为女性。临床上,只有五分之二的患者有中枢神经系统受累的特征.46例患者均有脑脊液（CSF）和影像学异常。12例（23.5％）患者被诊断为明确类别的结核性脑膜炎。梗死的存在与神经系统特征显着相关。Mantoux阳性与脉络膜结节的存在显着相关，脑脊液改变和脑结核瘤。
结论：这是第一项支持Wallgren在免疫功能正常的成年人中观察到的研究。高度怀疑，即使在无症状的患者中，可能会发现涉及中枢神经系统的结核性病变，并指导患者的最佳监测。
方法：这是三级护理，大学医院，前瞻性评估于2018年12月至2020年6月进行。新诊断的肺结核患者进行了详细的临床，实验室和基于MRI的评估。所有患者均按照WHO指南接受治疗。
结果：在342例肺结核患者中，53名患者符合资格标准。就诊时的中位年龄为32岁，约三分之二的患者为女性。临床上,只有五分之二的患者有中枢神经系统受累的特征.46例患者均有脑脊液（CSF）和影像学异常。12例（23.5％）患者被诊断为明确类别的结核性脑膜炎。梗死的存在与神经系统特征显着相关。Mantoux阳性与脉络膜结节的存在显着相关，脑脊液改变和脑结核瘤。
结论：这是第一项支持Wallgren在免疫功能正常的成年人中观察到的研究。高度怀疑，即使在无症状的患者中，可能会发现涉及中枢神经系统的结核性病变，并指导患者的最佳监测。
