Central nervous system tuberculosis in Western Sydney: a 10-year retrospective cohort study.

IF 1.8 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL
Hayden Zhang, Tasnim Hasan, Ravindra Dotel, Evan Ulbricht, Nicole Gilroy, Susan Maddocks
{"title":"Central nervous system tuberculosis in Western Sydney: a 10-year retrospective cohort study.","authors":"Hayden Zhang, Tasnim Hasan, Ravindra Dotel, Evan Ulbricht, Nicole Gilroy, Susan Maddocks","doi":"10.1111/imj.70017","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Central nervous system tuberculosis (CNS-TB) is a rare complication of tuberculosis. There is a lack of data surrounding investigation and management of this in Australia.</p><p><strong>Aim: </strong>To review CNS-TB cases in Western Sydney, Australia, and understand the epidemiology, investigation, diagnosis, management and outcomes in a low-prevalence setting.</p><p><strong>Methods: </strong>Retrospective cohort study of all CNS-TB patients managed in Western Sydney from 2013 to 2022. Demographics, risk factors, clinical presentation, investigations and management were reviewed. Clinical outcomes like hospital length-of-stay, adverse drug reactions, paradoxical reactions, functional disability and treatment outcomes, including cure, treatment failure, loss to follow-up and death, were also measured.</p><p><strong>Results: </strong>Thirty-nine CNS-TB cases were identified, with 16 (41%) confirmed by nucleic acid amplification test or culture of CNS specimens and 23 (59%) diagnosed presumptively without CNS microbiological confirmation. The median age was 32 years. Thirty-seven (95%) were overseas-born; 27 (69%) had no comorbidities. Presenting symptoms included fever (82%), headache (64%) and weight loss (51%). Twenty-five (64%) used fluoroquinolones and nine (23%) used high-dose rifampicin. Steroids were used in all patients. Six (15%) were prescribed aspirin for primary stroke prevention. Twenty-eight (73%) completed treatment, with one requiring re-treatment for presumed treatment failure. Six (15%) were lost to follow-up, and five (13%) died during their treatment course. Twenty-one (54%) experienced an adverse drug reaction.</p><p><strong>Conclusion: </strong>Tuberculosis is an ongoing public health issue in Australia, with CNS-TB being its most devastating form, and all clinicians to be aware of this rare complication. The efficacy of newer treatment options requires further study.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8000,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Internal Medicine Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/imj.70017","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0

Abstract

Background: Central nervous system tuberculosis (CNS-TB) is a rare complication of tuberculosis. There is a lack of data surrounding investigation and management of this in Australia.

Aim: To review CNS-TB cases in Western Sydney, Australia, and understand the epidemiology, investigation, diagnosis, management and outcomes in a low-prevalence setting.

Methods: Retrospective cohort study of all CNS-TB patients managed in Western Sydney from 2013 to 2022. Demographics, risk factors, clinical presentation, investigations and management were reviewed. Clinical outcomes like hospital length-of-stay, adverse drug reactions, paradoxical reactions, functional disability and treatment outcomes, including cure, treatment failure, loss to follow-up and death, were also measured.

Results: Thirty-nine CNS-TB cases were identified, with 16 (41%) confirmed by nucleic acid amplification test or culture of CNS specimens and 23 (59%) diagnosed presumptively without CNS microbiological confirmation. The median age was 32 years. Thirty-seven (95%) were overseas-born; 27 (69%) had no comorbidities. Presenting symptoms included fever (82%), headache (64%) and weight loss (51%). Twenty-five (64%) used fluoroquinolones and nine (23%) used high-dose rifampicin. Steroids were used in all patients. Six (15%) were prescribed aspirin for primary stroke prevention. Twenty-eight (73%) completed treatment, with one requiring re-treatment for presumed treatment failure. Six (15%) were lost to follow-up, and five (13%) died during their treatment course. Twenty-one (54%) experienced an adverse drug reaction.

Conclusion: Tuberculosis is an ongoing public health issue in Australia, with CNS-TB being its most devastating form, and all clinicians to be aware of this rare complication. The efficacy of newer treatment options requires further study.

西悉尼的中枢神经系统结核:一项10年回顾性队列研究。
背景:中枢神经系统结核(CNS-TB)是一种罕见的结核病并发症。澳大利亚缺乏相关的调查和管理数据。目的:回顾澳大利亚西悉尼的CNS-TB病例,了解低患病率环境下的流行病学、调查、诊断、管理和结果。方法:对2013年至2022年西悉尼所有CNS-TB患者进行回顾性队列研究。回顾了人口统计学、危险因素、临床表现、调查和管理。临床结果,如住院时间、药物不良反应、矛盾反应、功能残疾和治疗结果,包括治愈、治疗失败、随访损失和死亡,也被测量。结果:共发现CNS- tb病例39例,经CNS标本核酸扩增试验或培养确诊16例(41%),未经CNS微生物学确证推定诊断23例(59%)。中位年龄为32岁。其中37人(95%)在海外出生;27例(69%)无合并症。症状包括发烧(82%)、头痛(64%)和体重减轻(51%)。25人(64%)使用氟喹诺酮类药物,9人(23%)使用大剂量利福平。所有患者均使用类固醇。6人(15%)被开阿司匹林用于初级卒中预防。28例(73%)完成了治疗,其中1例因假定治疗失败而需要重新治疗。6例(15%)失去随访,5例(13%)在治疗过程中死亡。21例(54%)出现药物不良反应。结论:结核病在澳大利亚是一个持续的公共卫生问题,CNS-TB是其最具破坏性的形式,所有临床医生都应该意识到这种罕见的并发症。新的治疗方案的疗效需要进一步研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Internal Medicine Journal
Internal Medicine Journal 医学-医学:内科
CiteScore
3.50
自引率
4.80%
发文量
600
审稿时长
3-6 weeks
期刊介绍: The Internal Medicine Journal is the official journal of the Adult Medicine Division of The Royal Australasian College of Physicians (RACP). Its purpose is to publish high-quality internationally competitive peer-reviewed original medical research, both laboratory and clinical, relating to the study and research of human disease. Papers will be considered from all areas of medical practice and science. The Journal also has a major role in continuing medical education and publishes review articles relevant to physician education.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信