Worsening CSF parameters after the start of anti-tuberculosis treatment predicts intracerebral tuberculoma development. (December 2020)

• Record Type: Journal Article
• Authors: Lu, Yuying; Hu, Zhongyang; Wang, Fuyan; Yao, Huan; Zhu, Haixia; Wang, Zhen; Song, Zhi; Chen, Ru; Liu, Ding
• Is Part Of: International journal of infectious diseases. Volume 101(2020)
• Page Start: 395
• Page End: 402
• Publication Date: 2020-12
• Subjects: Tuberculomas -- Tuberculous meningitis -- Paradoxical reactions -- Cerebrospinal fluid -- HIV negative adults; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2020.09.1457
• Languages: English
• ISSNs: 1201-9712

Abstract

Highlights: Paradoxical tuberculomas are associated with early CSF deterioration. Neutrophils play an important role in tuberculosis-associated paradoxical reactions. Early worsening of CSF parameters predicts subsequent development of tuberculomas. Abstract: Objectives: We investigated whether early worsening of cerebrospinal fluid (CSF) predicts the later paradoxical tuberculomas and is a potential predictive biomarker. Methods: Patients of HIV-negative tuberculous meningitis fulfilling the inclusion criteria(n = 98) underwent clinical and CSF evaluation, together with repeated neuroimaging. We compared the baseline clinical data and continuous CSF of patients who did (n = 36) and did not (n = 62) develop paradoxical tuberculomas, and reported the changes associated with symptomatic tuberculomas. A logistic regression analysis was developed to reveal predictors for paradoxical tuberculomas. Results: The proportion of worsening CSF parameters (WBC count and percent neutrophils) in the paradoxical tuberculomas group (27/36, 75.0%) was significantly higher than the non-paradoxical tuberculomas group (15/62, 24.2%). The logistic regression analysis revealed that worsening CSF parameters was the highest risk predictor for paradoxical tuberculomas. Most worsening CSF parameters (81.0%) occurred within two weeks after treatment (2–24 days, median 7 days), and paradoxical tuberculomas commonly happened two weeks later (12 days to 13 months, median 22 days). The period between worsening CSF parameters and paradoxical tuberculomas ranged from 6 to 383 days (median 21days). There were no significant differences in mortality and prognosis between the two groups. Conclusions: Early worsening of CSF parameters predicts subsequent development or progression of tuberculomas.