Perplexing paradoxical reactions: navigating the complexity of protracted tuberculosis meningitis—a case report
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Le résumé fourni par la source
Tuberculous meningitis (TBM) has considerable mortality and morbidity, and it often presents therapeutic challenges when complicated by paradoxical reactions (PRs). Here, the clinical course of four cases of TBM patients complicated by PRs in a longitudinal TB cohort is described while also providing insights from the larger clinical cohort. Research flow cytometry, biomarker analysis, and drug concentrations were performed on available samples. All participants were initiated on standard antituberculosis therapy (ATT) and enrolled at the onset of PRs (PR group) or 2-4 months after the start of ATT (controls). The four TBM participants highlighted here presented with fevers, headaches, neurological deficits, and fatigue at the initial presentation. Upon diagnosis, all were initiated on rifampin, isoniazid, pyrazinamide, and ethambutol (RHZE) at standard doses and on corticosteroids. The median time to first PR was 37 days with recrudescence of initial TBM signs and symptoms at the time of PR. At the time of referral, all participants had low drug concentrations requiring dose optimization and regimen intensification as well as recrudescent flares upon corticosteroid taper, with one individual developing enlargement of tuberculoma 1 year following completion of ATT. Based on biomarkers and flow cytometry, PRs are characterized by elevated interferon-gamma and ferritin levels in the plasma compared to controls. In the TBM participants, T-cell activation with elevated levels of inflammatory biomarkers in the cerebrospinal fluid (CSF) was seen at the time of PR. These unique and highly detailed TBM cases provide insights into the pathogenesis of PRs, which may assist with future diagnostics and treatment.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Perplexing paradoxical reactions: navigating the complexity of protracted tuberculosis meningitis—a case report
- Date Crossref
- 31/10/2024
- Éditeur
- Frontiers Media SA
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Frederick National Laboratory for Cancer Research pays non établi dans la noticeStructure de recherche
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National Institutes of Health Clinical Center pays non établi dans la noticeÉtablissement de santé
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National Institutes of Health pays non établi dans la noticeOrganisme public
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National Institute of Allergy and Infectious Diseases pays non établi dans la noticeStructure de recherche
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University of Maryland Division of Pulmonary and Critical Care Medicine pays non établi dans la noticeUniversité ou école supérieure
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and Blood Institute Lung pays non établi dans la noticeStructure de recherche
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Howard County Health Department pays non établi dans la noticeOrganisme public
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Baltimore City Health Department pays non établi dans la noticeOrganisme public
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Montgomery County Department of Health and Human Services pays non établi dans la noticeOrganisme public
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Clinical Research Directorate pays non établi dans la noticeÉtablissement de santé
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NIH Clinical Center Center for Infectious Disease Imaging pays non établi dans la noticeÉtablissement de santé
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Howard County Department of Health pays non établi dans la noticeInstitution
Frederick National Laboratory for Cancer Research, National Institutes of Health Clinical Center et National Institutes of Health, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.