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.
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。