Academic literature on the topic 'Tuberculosis, Meningeal – epidemiology'

Background. To know the current status of the epidemiological and geographic distribution of tuberculosis and its complication meningeal tuberculosis in Mexico, this work analyzes national surveillance data (ten years) issued by the General Directorate of Epidemiology (GDE). Methods. An observational and retrospective analysis of monthly and annual reports of pulmonary and meningeal tuberculosis cases from January 2007 to December 2017 was performed on the annual reports issued by the GDE in Mexico. The number of cases and incidence were classified by year, state, age group, gender, and seasons. Results. A national case distribution map of pulmonary and meningeal tuberculosis incidence was generated. During this period, a total of 184,003 and 3,388 cases were reported with a median of 16,727.5 and 308 cases per year for pulmonary and meningeal tuberculosis diseases, respectively. The number of cases and incidence of pulmonary and meningeal tuberculosis per year showed that male gender presented a continuous increase in both parameters. The geographic analysis of the distribution of cases of tuberculosis showed that states like Guerrero, Tabasco, and Veracruz presented higher means of tuberculosis cases during this period. Northern states had the highest number of cases in the country compared to other states. In Mexico, pulmonary tuberculosis and meningeal tuberculosis are seasonal. Interestingly, cases of meningeal tuberculosis show an increase during October and November (autumn). Conclusions. In Mexico, during the years 2007–2017, there has been an increase in the proportion of male TB patients. It remains necessary to implement strategies to detect TB in the adult population, especially among men, because tuberculosis could be difficult to recognize in an early stage in the population, and the appearance of resistant strains can cause an increase in the incidence of the disease.

AbstractCentral nervous system (CNS) involvement of tuberculosis (TB) is the most severe manifestation of TB and accounts for approximately 5 to 10% of all extrapulmonary TB (EPTB) cases and approximately 1% of all TB cases. TB meningitis (TBM) is the most common form of CNS TB, though other forms occur, often in conjunction with TBM, including intracranial tuberculomas, tuberculous brain abscesses, and spinal tubercular arachnoiditis. CNS TB often presents with nonspecific clinical features that mimic symptoms of other neurological conditions, often making diagnosis difficult. Defining neuroimaging characteristics of TBM include thick basal meningeal enhancement, hydrocephalus, and parenchymal infarctions most commonly involving the basal ganglia and internal capsule. Traditional cerebrospinal fluid sample analysis frequently requires lengthy times-to-result and have low sensitivity. Given the pitfalls of conventional CNS TB diagnostic methods, various molecular-based methods, including immunoassays and polymerase chain reaction (PCR)-based assays have emerged as alternative diagnostic tools due to their rapidity, sensitivity, and specificity. Expert panels on TBM have recently emphasized the need for standard research procedures with updated case definitions and standardized study methods, which will hopefully pave the way for more robust multicenter international studies. In this article, we review the epidemiology, diagnosis, molecular factors associated with disease presentation and outcome, and treatment of CNS TB.

Background. Central nervous system tuberculosis is one of the most severe forms of extra-pulmonary tuberculosis. Tuberculous meningoencephalitis (TBM) is highly prevalent globally in resource-limited countries and in patients with immunosuppression. We present here a case of meningoencephalitis with proved acute Herpes simplex virus infection. However, our patient responded to antituberculosis therapy. This raises the possibility that some cases of “idiopathic” (cryptogenic) meningoencephalitis may represent occult tuberculosis disease. Result. A 22-year-old woman was admitted to our hospital because of fever, headache and hallucinations. Neck stiffness and other meningeal symptoms were present. CSF examination showed lymphocyte-dominant pleocytosis and a decreased level of glucose. Both Herpes simplex virus type 1 (HSV-1) DNA and IgG antibodies to the virus were found in the CSF sample. Although antibiotics and acyclovir were administered, fever, disturbance of consciousness, hallucinations and meningeal signs intensified. A second CSF sample obtained a week after the collection of the first one contained higher level of cytosis and so called “spider-web” cloth (SWC). As a result, the diagnosis was revised: tuberculosis was regarded as the most likely cause of the disease. The patient started receiving antituberculous treatment. Soon after the medications were changed, the meningoencephalitis started to subside and was finally cured. Judging from the clinical features, the CSF and MRI findings, the effectiveness of antituberculous drugs, the final diagnosis was made as tuberculous meningoencephalitis. From all these things, we conclude when even antibodies for Herpes viruses and viral DNA are present in the CSF of the patient with sterile meningoencephalitis the possibility of latent involvement in the process of Koch bacteria (KB) should be kept in mind. Conclusion. The patient’s symptoms and signs began to resolve with antituberculous therapy. Resolution of the lesions was confirmed by magnetic resonance imaging. We conclude that this case represented occult tuberculous disease. An empiric trial of antituberculous therapy may be used in other cases of apparently idiopathic meningoencephalitis.

<p><strong>Introduction:</strong> Extra-Pulmonary Tuberculosis (EPTB) gained attention for study its local disease epidemiology for disease control.</p><p><strong>Objective:</strong> To study the distribution and determinants of EPTB in randomly selected tuberculosis units (TUs) of Himachal Pradesh. <strong>Methodology:</strong> Multistage random sampling was used; four districts were selected randomly from total 12 districts of state and then one TU was selected from each selected district. In addition, two medical colleges were also included as a referral point for EPTB cases. </p><p><strong>Results:</strong> Total 463 EPTB cases were studied during one-year study period; pleural (41.9%) and Lymph Node (31.3%) was frequently observed involved sites. Among male's pleural effusion (48.2%) was commonly involved site followed by lymph node (23.5%), whereas, lymph node was involved in 40.6% followed by pleural effusion in 34.4% females. Other common sites for EPTB were abdomen (6.0%), bone (5.6%), meninges (5.2%) and pericardium (3.9%) and for both males and females. Mean duration of diagnosis since appearance of symptoms was 40 days; only 10.0% of patients received antibiotics for the average of two weeks before formulating EPTB diagnosis. About 35.0% patients underwent FNAC (Fine Needle Aspiration Cytology) to establish diagnosis.</p><p><strong>Conclusion:</strong> Invasive diagnostic facilities at peripheral health institutions will help further to better understand EPTB epidemiology.</p>

Tuberculous meningitis (TBM) results from dissemination of M. tuberculosis to the cerebrospinal fluid (CSF) and meninges. Ischaemia, hydrocephalus and raised intracranial pressure frequently result, leading to extensive brain injury and neurodisability. The global burden of TBM is unclear and it is likely that many cases are undiagnosed, with many treated cases unreported. Untreated, TBM is uniformly fatal, and even if treated, mortality and morbidity are high. Young age and human immunodeficiency virus (HIV) infection are potent risk factors for TBM, while Bacillus Calmette–Guérin (BCG) vaccination is protective, particularly in young children. Diagnosis of TBM usually relies on characteristic clinical symptoms and signs, together with consistent neuroimaging and CSF parameters. The ability to confirm the TBM diagnosis via CSF isolation of M. tuberculosis depends on the type of diagnostic tests available. In most cases, the diagnosis remains unconfirmed. GeneXpert MTB/RIF and the next generation Xpert Ultra offer improved sensitivity and rapid turnaround times, and while roll-out has scaled up, availability remains limited. Many locations rely only on acid fast bacilli smear, which is insensitive. Treatment regimens for TBM are based on evidence for pulmonary tuberculosis treatment, with little consideration to CSF penetration or mode of drug action required. The World Health Organization recommends a 12-month treatment course, although data on which to base this duration is lacking. New treatment regimens and drug dosages are under evaluation, with much higher dosages of rifampicin and the inclusion of fluoroquinolones and linezolid identified as promising innovations. The inclusion of corticosteroids at the start of treatment has been demonstrated to reduce mortality in HIV-negative individuals but whether they are universally beneficial is unclear. Other host-directed therapies show promise but evidence for widespread use is lacking. Finally, the management of TBM within health systems is sub-optimal, with drop-offs at every stage in the care cascade.

Abstract BACKGROUND There is little detailed epidemiologic and clinical data about tuberculosis (TB) disease in children in Canada. OBJECTIVES This study characterizes the epidemiologic, clinical, and treatment data for all cases of TB in children under age 15 in Canada surveyed through the Canadian Paediatric Surveillance Program’s (CPSP) Childhood Tuberculosis Study from October 2013 to September 2016. DESIGN/METHODS New active TB cases were identified through a monthly form sent by the CPSP to approximately 2500 active paediatricians, paediatric subspecialists, and select non-paediatricians who manage childhood TB. For cases meeting inclusion criteria, a detailed questionnaire was sent to the treating physician to collect clinical, epidemiological, and treatment data, followed by 6-month follow-up surveys until 6 months after treatment completion. Cases were reviewed by at least one TB specialist for inclusion and classification of disease. RESULTS Of 285 unique incident cases reported, 188 cases met inclusion criteria, returned a detailed questionnaire, and were classified. Selected demographic data are shown in Table 1. 92% of cases had intrathoracic involvement (N=172, 91%), but a minority were confirmed by culture or nucleic acid amplification (62/172, 36%). The most common sites of intrathoracic involvement were lymph nodes (N=118, 69%) and lungs (N=54, 31%). There were 143 attempted respiratory microbiological studies, with 32 (22%) yielding a positive culture or NAAT in sputum and 33 (23%) in gastric aspirate. Highest yield was in the 10+ age group with 54% (20/37) positivity. 31 cases of extrathoracic TB were recorded, with 19/35 (54%) having simultaneous intrathoracic TB. The most common forms of extrathoracic TB included CNS or meningeal disease (N=13) and extrathoracic lymphadenopathy (N=11). Miliary or disemminated disease (2 or more non-continguous sites involved) was found in 15 cases (8%). 16 cases reported at least one adverse drug reactions, with pyrazinamide (N=10) and isoniazid (N=5) being most common. 4 children were hospitalized and the most common ADR was hepatotoxicity. There was one case of multi-drug resistant TB. CONCLUSION This study suggests a high incidence of TB in Inuit and First Nations children, as well as a higher proportion of extrathoracic TB and greater success in culture positivity in children aged 10+. It also shows a significant number of adverse drug reactions to anti-TB treatment. Further analysis of this data will serve to refine practice in monitoring, detecting, and treating this infection.

I-1 RESPUESTA PARADOJICA AL TRATAMIENTO ANTITUBERCULOSO EN UN PACIENTE CON TUBERCULOSIS MENINGEA Y ESPINAL, A PROPOSITO DE UN CASO (RESTREPO ANDREA, CLAVIJO ABSALÓN, GÓMEZ DIANA, AGUDELO CARLOS ANDRÉS) I-2 TRATAMIENTO EXITOSO CON FOSCARNET EN LESIONES ATÍPICAS DE VIRUS HERPES SIMPLE EN COINFECCIÓN CON VIRUS DE INMUNODEFICIENCIA HUMANA (RODRIGUEZ HERRERA DANIELA, PATIÑO GIRALDO SANTIAGO) I-3 LESIÓN RENAL AGUDA SECUNDARIO A TOXINA DE LONOMIA OBLIQUA (ARSANIOS DANIEL, QUINTERO ELIAS, SANTOYO NICOLÁS, MUÑOZ CARLOS) I-4 PIOMIOSITIS EN MUSLO POR PSEUDOMONAS (COGOLLO MARYSABEL, BORRÉ DIANA) I-5 SÍNDROME HEMOFAGOCÍTICO COMO MANIFESTACIÓN DE SÍNDROME DE WEIL (ARAGÓN DIANA, GUTIÉRREZ MARGARITA, CONCHA DIANA, OSPINA MARÍA, SÁNCHEZ ALEXANDER, ENCISO LEONARDO) I-6 DISFUNCION MULTIORGANICA POR ABSCESO PERINEFITICO BILATERAL MAS ABSCESO HEPATICO (COGOLLO GONZÁLEZ MARYSABEL, ALVARADO CUETO DANIEL, JULIO NARVAEZ LUIS CARLOS) I-7 ANGINA DE LUDWIG CON COMPROMISO DE VÍA AÉREA EN PACIENTE AÑOSA (ORDOÑEZ KARINA, ARTETA SHEILA) I-8 TUBERCULOSIS MENINGEA Y OTRAS MANIFESTACIONES INFRECUENTES DE TUBERCULOSIS DISEMINADA EN HUÉSPED INMUNOCOMPETENTE (DE LA VEGA FERNANDO, VARGAS-HERNÁNDEZ MARÍA, PACHECOCUMPLIDO ARNULFO, BLANCO-REYES SILVIA, RODRIGUEZ-YANEZ TOMÁS) I-9 ESPONDILODISCITIS INFECCIOSA SECUNDARIO A CUSHING FARMACOLOGICO (KARINA ORDOÑEZ, ALAN SEPÚLVEDA, GERMAN VICIOSO) I-10 ANAPLASMOSIS GRANULOCITOTRÓPICA HUMANA: ZOONOSIS EMERGENTE EN PACIENTE INMUNOSUPRIMIDO POR VIH (DE LA VEGA FERNANDO, GUTIÉRREZ-CUESTA JORGE, MARTÍNEZPINTO JUAN, PACHECO-CUMPLIDO ARNULFO, BLANCO-REYES SILVIA, RODRIGUEZ-YANEZ TOMÁS) I-11 VENTRICULITIS POR CITOMEGALOVIRUS EN PACIENTE INMUNOCOMPROMETIDO AFRICANO (LOPEZ FERNEY ALBEIRO, AFRICANO LOPEZ HOLMAN LEONARDO) I-12 ELEVACIÓN TRANSAMINASAS E INFECCION POR EPSTEIN-BARR, UNA ENTIDAD PARA NO OLVIDAR (GARCÍA DIANA, ALZA JHONGERT, POVEDA GUSTAVO, ALZA LYZINHAWER) I-13 TUBERCULOSIS HEPÁTICA AISLADA EN PACIENTE INMUNOCOMPETENTE: REPORTE DE CASO (OCAMPO MARIA ISABEL, ARENAS MAYRA, FONSECA JUAN FERNANDO, RUMBO JOSÉ ALEJANDRO, DAVID DAVID, SALAZAR LUKAS, BUSTOS MARLON) I-14 LOXOCELISMO CUTÁNEO NECRÓTICO (MARÍA ÁNGELA CASTELLANOS-GUTIÉRREZ, DEISY RODRIGUEZ-BERDUGO) I-15 BACTEREMIA POR ACINETOBACTER URSINGII EN PACIENTE INMUNOCOMPETENTE (MARTÍN DANIEL, BARRAGÁN ANDRÉS, GARZÓN DIANA) I-16 GLUCANTIME Y PROLONGACIÓN DEL QTC: UNA COMBINACIÓN FATAL (DUQUE LAURA, LÓPEZ HELBER, NARANJO SEBASTIÁN, ARISTIZÁBAL JULIÁN, DUQUE MAURICIO) I-17 ASPERIGILOSIS INVASIVA INTESTINAL, UN GERMEN UBICUO EN UNA LOCALIZACIÓN INUSUAL (NARANJO JULIÁN, ACOSTA MARÍA FERNANDA, ARAGÓN DIANA, GUERRA JOAQUÍN, NOREÑA IVÁN) I-18 ENDOCARDITIS INFECCIOSA POR GEMELLA SANGUINIS: PRIMER REPORTE DE CASO EN COLOMBIA (ESPINOSA-SERNA JUAN SEBASTIÁN, DUARTE LUISA, NOREÑA IVÁN. ) I-19 MENINGOENCEFALITIS AGUDA POR STREPTOCOCCUS AGALACTIAE EN ADULTO JOVEN (ÁLVAREZ CAMILO, RESTREPO CARLOS, NAVARRETE LINDA, PRIETO JAVIER, CUERVO JESSICA, MÉNDEZ JUAN) I-20 CANDIDIASIS ESOFAGICA EN PACIENTE CON INMUNODEFICIENCIA STAT-1 (CÁRDENAS LAURA, DONOSO LAURA, GÓMEZ PAULA, JOHNSON NATALIA, NOVA DORA, TORRALBA FELIPE) I-21 MASA OVÁRICA, ASCITIS Y CA 125 ELEVADO, TAMBIÉN PUEDE SER TUBERCULOSIS (NARANJO JULIO, MORALES XIMENA, CORTES CAMILO) I-22 CRIPTOCOCOSIS DISEMINADA POR CRYPTOCOCCUS GATTII (MÉNDEZ JORGE, RINCÓN SONIA, TOLE CAMILA, SANDOVAL LINA, BUSTOS MARLON) I-23 HISTOPLASMOSIS DISEMINADA EN PACIENTE DIABÉTICO (CONTRERAS ALEJANDRA, CORTÉS CAMILO) I-24 HISTOPLASMOSIS DISEMINADA EN INMUNOCOMPETENTES (TRUJILLO DANIELA, RUIZ LUIS MIGUEL, RESTREPO RICARDO, VEGA JULIANA) I-25 ABSCESO ESPLÉNICO DEBIDO A ENTEROBACTER AEROGENES (MAYORGA CAROL, CHAAR ALDAIR, CALDERÓN MAURICIO, VERA JUAN, MARTIN DANIEL, VESGA DANIEL) I-26 SÍNDROME DEL ABSCESO HEPÁTICO POR KLEBSIELLA PNEUMONIAE INVASORA (TORRES BUSTAMANTE ÁNGELA MARÍA, CASTAÑEDA CAMACHO HÉCTOR ANDRÉS. ) I-27 TUBERCULOSIS HEPATICA AISLADA: UNA CAUSA RARA DE TUMORES HEPATICOS (DE LA VEGA FERNANDO, CÓRDOBA-CABALLERO ANGIE, RODRIGUEZ-YANEZ TOMÁS, GARCÍA-PRADA CAMILO) I-28 HISTOPLASMOSIS PERITONEAL EN UN PACIENTE INMUNOCOMPROMETIDO (SIERRA UMAÑA SEBASTIÁN FELIPE, ROSERO PAREDES SILVIO JAVIER, URRUTIA CORREDOR LAURA CAMILA, BARRIOS VILLEGAS JUAN ESTEBAN, ARCE CUERVO JULIANA) I-29 PRESENTACIÓN INUSUAL DE CRIPTOCOCOSIS CEREBRAL COMO LESIÓN TUMORAL INTRACRANEAL EN PACIENTE CON ANTECEDENTE DE GLIOBLASTOMA CEREBRAL (REYES TOLEDO RAÚL, MESA ZULUAGA MARIA, GÓMEZ QUINTERO CARLOS, RIVAS PILAR) I-30 EMPIEMA PLEURAL POR SALMONELLA EN PACIENTE CON LUPUS ERITEMATOSO SISTÉMICO (CONTRERAS ALEJANDRA, NOVOA DANNY) I-31 RECIDIVA DE LEPRA, EN PACIENTE INICIALMENTE DIAGNOSTICADO CON DERMATITIS EXFOLIATIVA ASOCIADA A MEDICACIÓN ANTITUBERCULOSA (MESA ZULUAGA MARÍA ALEJANDRA, MEDINA AHUMADA PATRICIA) I-32 MICOBACTERIA DE CRECIMIENTO RÁPIDO EN UN PACIENTE CON USO DE ANTI-TNF (GUTIÉRREZ-BOLAÑOS JOHANN, VARELA DIANA-CRISTINA, GARCÍA-RINCÓN CRISTIAN-IVÁN) I-33 PARACOCCIDIOIDOMICOSIS COMO CAUSA DE INSUFICIENCIA SUPRARRENAL, UN RETO DIAGNOSTICO PARA UNA CAUSA INSOSPECHADA (SANTACRUZ DEVIA JUAN CAMILO, PARAMO DÍAZ LAURA ISABEL, NARANJO JULIÁN, ARAGÓN DIANA MARCELA) I-34 HISTOPLASMOSIS DISEMINADA EN PACIENTE CON LUPUS ERITEMATOSO SISTEMICO (VISUALIZACIÓN DIRECTA EN MEDULA ÓSEA) (GRANELA KATYA, BROCHADO LEONARDO) I-35 PAPEL DEL VIRUS EPSTEIN BARR EN LA PATOGENIA DE LA ENCEFALOMIELITIS AGUDA DISEMINADA (LUIS DULCEY, JONATHAN PINEDA, WILLIAM GONZÁLEZ, RODOLFO MARTHEYN, RAIMONDO CALTAGIRONE, BELKIS MENONI, PEDRO QUIJADA. ) I-36 INFECCIÓN FÚNGICA INVASORA EN PACIENTE NO NEUTROPÉNICO (GÓMEZ PACHÓN CAMILO ANDRÉS, BRAVO OJEDA JUAN SEBASTIÁN, GONZÁLEZ SALEBE VÍCTOR MANUEL, RAMOS CUELLAR GINA ALEXANDRA, PÉREZ FRANCO JAIRO ENRIQUE) I-37 PROFILAXIS ANTIBIÓTICA EN PROCEDIMIENTOS ODONTOLÓGICOS PARA PREVENIR ENDOCARDITIS BACTERIANA: UNA REVISIÓN BIBLIOMÉTRICA (MUÑOZ LOMBO JENNY PATRICIA, GIL GUTIÉRREZ CARLOS ENRIQUE, GIL RODRÍGUEZ KARLA JOHANNA, GONZÁLEZ AROSEMENA JULIANA, GUERRERO REYNA FELIPE) I-38 EMPIEMA NECESSITATIS POR SALMONELLA CON COMPLICACION CON QUILOTORAX (PUENTES CASTRILLON MARIA ELCY, CORREA ALDANA JOHN JAIRO, DOMINGUEZ RUIZ JUAN DIEGO, PUENTES CASTRILLON JOSE JOVANY, SALINAS CORTES DIEGO, ZULUAGA BEDOYA MAURICIO) I-39 INFECCIÓN DE INJERTO VASCULAR AÓRTICO POR CÁNDIDA (AMAYA NICOLÁS, JARAMILLO PABLO, RUIZ PAULA) I-40 SÍNDROME INVASIVO POR KLEBSIELLA PNEUMONIAE HIPERMUCOVISCOSA. UNA VARIANTE CLINICA AGRESIVA (PUENTES CASTRILLON MARIA ELCY, TINJACA MONTAÑO KARENT MARGARITA, DOMINGUEZ RUIZ JUAN DIEGO, PUENTES CASTRILLON JOSE JOVANY, SALINAS CORTES DIEGO FERNANDO) I-41 FIEBRE DE ORIGEN DESCONOCIDO COMO MANIFESTACIÓN DE ENFERMEDAD DE CASTLEMAN Y SARCOMA DE KAPOSI EN PACIENTE CON VIH (AMAYA NICOLÁS, RUIZ PAULA, RUMBO JOSÉ) I-42 CROMOMICOSIS (PRETTEL JOSÉ, CAMACHO FRANCISCO, COGOLLO MARYSABEL, RAMÍREZ DIANA, BOLAÑO LUIS, BAZA LISBETH, DOMÍNGUEZ FABIÁN, RODRÍGUEZ REINHARD) I-43 MAL DE POTT EN PACIENTE INMUNOCOMPETENTE (BUSTOS MARLON, GARCÍA JUAN DAVID, SANCHEZ PAULA MARÍA, AGREDA DIANA) I-44 VASCULITIS DEL SISTEMA NERVIOSO CENTRAL POR CITOMEGALOVIRUS EN PACIENTE INMUNOCOMPETENTE (ALZATE JOHN ALEXANDER, ARIAS DANIEL RICARDO, LÓPEZ JESSICA ANDREA) I-45 CRIPTOCOCOSIS CEREBELOSA: UNA FORMA INUSUAL DE PRESENTACION (BRAVO PADILLA VÍCTOR, OCAMPO JOSÉ MAURICIO, CASANOVA MARÍA EUGENIA, OSORIO CINDY VERÓNICA) I-46 CARACTERIZACIÓN DEL PERFIL INFECCIOSO DE PACIENTES CON ENFERMEDADES AUTOINMUNES ATENDIDOS EN CENTRO ESPECIALIZADO (DÍAZ-CORONADO JUAN C, ROJAS-VILLARRAGA ADRIANA, HERNANDEZ-PARRA DEICY, PEREZ-ESTRADA PAULA, BETANCURVÁSQUEZ LAURA, LACOUTURE-FIERRO JORGE, GONZALEZHURTADO DANIEL, GONZALEZ- ARANGO JUANITA, URIBE- ARANGO LAURA, GAVIRIA-AGUILAR MARIA C, PINEDA-TAMAYO RICARDO A. ) I-47 SÍNDROME DE WEIL: A PROPÓSITO DE UN CASO DE LEPTOSPIROSIS (PATIÑO LUISA, BUSTOS MARLON, BUSTAMANTE ÁLVARO, RODRIGUEZ MARTHA PATRICIA) I-48 ENDOCARDITIS FUNGICA DE VÁLVULA TRICUSPIDEA PROTÉSICA EN PACIENTE INMUNOSUPRIMIDO NO USUARIO DE DROGAS ENDOVENOSAS (PLATA JUAN, ARAGÓN DIANA, NARANJO JULIÁN, NOREÑA IVAN) I-49 EPIDEMIOLOGIA DE LA LEPTOSPIROSIS EN EL DEPARTAMENTO DEL HUILA DURANTE LOS AÑOS 2011 A 2017 (ARCE POLO ANGIE VANESSA, CHICA POLANIA MARIA VALENTINA, CEDEÑO CHACÓN GUSTAVO, GÓMEZ-CERQUERA JUAN MANUEL, TAFURT-CARDONA YALIANA) I-50 ESPECTRO CLÍNICO DE LA SIMBIOSIS VIH Y CRIPTOCOCO EN UN HOSPITAL PÚBLICO DE ALTA COMPLEJIDAD DE LA CIUDAD DE MEDELLÍN (CALLE-ESTRADA MATEO, BERRIO-MEDINA INDIRA, JIMÉNEZTABARES JULIANA, JARAMILLO-ARROYAVE DANIEL) I-51 IDENTIFICACIÓN DE MYCOBATERIUM BOVIS EN PACIENTES CON DIAGNOSTICO DE SEROSITIS TUBERCULOSA EN UN HOSPITAL DE CONCENTRACIÓN DE LA CIUDAD DE MÉXICO (YAMILE JURADO-HERNANDEZ, ALEJANDRO HERNÁNDEZ-SOLIS, MARIBEL GONZÁLEZ-VILLA, ERNESTO RAMÍREZ-GONZÁLEZ, HELEODORA GONZÁLEZ-GONZÁLEZ, RAÚL CÍCERO-SABIDO) I-52 UTILIDAD DE LOS MÉTODOS DIAGNÓSTICOS EN PACIENTES CON SEROSISTIS POR M. TUBERCULOSIS, EN UN HOSPITAL DE CONCENTRACIÓN DE LA CIUDAD DE MÉXICO (YAMILE JURADO-HERNANDEZ, ALEJANDRO HERNÁNDEZ-SOLIS, HELEODORA GONZÁLEZ-GONZÁLEZ, MARIBEL GONZÁLEZ-VILLA, ERNESTO RAMÍREZ-GONZÁLEZ, ARTURO REDING-BERNAL, RAÚL CÍCERO-SABIDO) I-53 HIPERINFECCIÓN POR STRONGYLOIDES EN PACIENTE CON TRASPLANTE DE HÍGADO (MANCERA PEDRO, MATEUS JUAN CAMILO, CASTAÑEDA XIMENA, MUGNIER JAQUELINE, HERNÁNDEZ ÁNGELA) I-54 HISTOPLASMA Y VIH: ANÁLISIS CLÍNICO Y DE LABORATORIO DE 20 PACIENTES EN HOSPITAL PUBLICO DE ALTA COMPLEJIDAD. (JIMÉNEZ-TABARES JULIANA, BERRIO-MEDINA INDIRA, CALLEESTRADA MATEO, JARAMILLO-ARROYAVE DANIEL) I-55 TUBERCULOSIS, RECONSTITUCION INMUNE E HISTOPLASMOSIS. UNA TRIADA POCO USUAL (GUERRA HAROL, BRICEÑO OSCAR, CORTES CAMILO) I-56 EMPIEMA NECESSITATIS POR ENTEROBACTERIAS (SALINAS-CORTES DIEGO FERNANDO, PERDOMO DANIELA, SALAMANCA-MONTILLA JHON F, MONDRAGÓN-CARDONA ALVARO) I-57 ASPERGILOSIS PULMONAR INVASIVA EN PACIENTE INMUNOCOMPETENTE (MEDINA AHUMADA PATRICIA, HERNÁNDEZ DANIEL) I-58 INFECCIÓN POR VARICELA ZOSTER DISEMINADA COMPLICADA CON HEPATITIS EN PACIENTE INMUNOCOMPETENTE (MEDINA AHUMADA PATRICIA, HERNÁNDEZ DANIEL) I-59 OSTEOMIELITIS DEL PUBIS (SIERRA UMAÑA SEBASTIÁN FELIPE, MUÑOZ ROSSI FELIPE ALEJANDRO, CASTILLO RODRÍGUEZ CRISTIAN ALEJANDRO, SALINAS MENDOZA SEBASTIAN, ALVEAR REALPE JONATHAN AMBROSIO, LÓPEZ DONATO DIEGO FERNANDO)

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfillment for the degree Masters of Medicine in Paediatrics (MMed) Johannesburg 2014
Introduction Mycobacterium tuberculosis meningitis (TBM) is a severe manifestation of extra-pulmonary tuberculosis (EPTB) in children, particularly under 5 years of age. Children are vulnerable to EPTB as they are immunologically immature and unable to contain Mycobacterium tuberculosis (MTB) infection in the lung. Common neurological sequelae of TBM include focal motor deficits, vision loss and hydrocephalus. Early stage diagnosis and timeous anti-tuberculosis treatment decreases the case fatality rate of TBM. Objective To characterise the burden, clinical presentation, laboratory markers and short-term outcome of TBM in HIV-infected and HIV-uninfected children. Methods The electronic databases of admission of children at Chris Hani Baragwanath Academic Hospital (CHBAH), between January 2006 and December 2011 with a diagnosis of TBM were reviewed. Individual patient records were retrospectively reviewed for clinical and laboratory data. In addition, admissions from the neurosurgery wards were also reviewed. In patients whose medical records were unavailable, laboratory data was used. Results The overall incidence of TBM in 2006 was 6.96 per 100 000 (95% Confidence Interval [95%CI]: 4.46-10.36), peaked at 9.87 per 100 000 (95% CI: 6.91-13.67) in 2009 and subsequently declined to 3.18 per 100 000 by 2011 (95% CI: 1.64-5.56). There was a 38.6% (95% CI: 10.0-58.0; p=0.011) reduction in the overall incidence of TBM when comparing the period 2006-2009 with the period 2010-2011. This decline was particularly evident in HIV-infected children (49.6% reduction; 95%CI: 1.05-74.35; p=0.042). There were no differences in the clinical symptoms of TBM or tuberculosis between HIV-infected and -uninfected children. Previous history of TB was significantly higher in HIV-infected children compared to HIV-uninfected children (OR 4.63; 1.40-15.22; p=0.011). Tuberculin skin test positive-reactivity (OR 0.09; 0.02-0.43; p=0.002) and sputum culture positivity (OR 0.29; 0.10-0.86; p=0.025) were less common in HIV-infected compared to -uninfected children. Cerebrospinal fluid cytology and biochemistry results were similar between HIV-infected compared to -uninfected children. Morbidity (22.7% in HIV-infected vs. 33.0% in -uninfected) and mortality (6.4% in HIV-infected vs. 6.9% in -uninfected) were similar between HIV-infected and -uninfected children. Conclusion The incidence of TBM has decreased over the study period 2006 to 2011.This decrease was temporally associated with an increase in the uptake of antiretroviral treatment in HIV-infected individuals.