Case Report

Diagnosis dan penatalaksanaan tuberkulosis sistem saraf pusat

Prima Yogi , I Putu Andrika, I Gede Ketut Sajinadiyasa, I Made Bagiada

Prima Yogi
Program Studi Pendidikan Dokter Spesialis Penyakit Dalam, Fakultas Kedokteran Universitas Udayana/RSUP Sanglah, Denpasar, Bali Indonesia. Email: primayogi2@gmail.com

I Putu Andrika
Departemen/KSM Penyakit Dalam, Fakultas Kedokteran Universitas Udayana/RSUP Sanglah, Denpasar, Bali Indonesia

I Gede Ketut Sajinadiyasa
Departemen/KSM Penyakit Dalam, Fakultas Kedokteran Universitas Udayana/RSUP Sanglah, Denpasar, Bali Indonesia

I Made Bagiada
Departemen/KSM Penyakit Dalam, Fakultas Kedokteran Universitas Udayana/RSUP Sanglah, Denpasar, Bali Indonesia
Online First: December 21, 2021 | Cite this Article
Yogi, P., Andrika, I., Sajinadiyasa, I., Bagiada, I. 2021. Diagnosis dan penatalaksanaan tuberkulosis sistem saraf pusat. Intisari Sains Medis 12(3): 912-916. DOI:10.15562/ism.v12i3.1173


Introduction: Central nervous system (CNS) tuberculous are the most dangerous form of extrapulmonary TB. CNS tuberculous can present as meningoencephalitis, intracranial tuberculomas, and vasculitis. CNS tuberculous accounts for about 1% of all TB cases and is associated with high mortality. Tuberculous meningoencephalitis commonly presents with classic symptoms of fever, headache, meningism (neck stiffness), seizures as well as focal neurologic deficits, and altered consciousness. The diagnosis and treatment of CNS tuberculosis is still a formidable clinical challenge.

Case report: Patient presented with fever, headache, meningismus, convulsion, and decreased consciousness. CT scan showed cerebral tuberculoma in the left parietal lobe. Examination gene-Xpert of the cerebrospinal fluid showed Mycobacterium tuberculosis. The patient was given category 1 of anti-tuberculosis drugs.

Conclusion: CNS tuberculosis has non-specific symptoms, difficult diagnosis, and high mortality. In this case report, the diagnosis of CNS tuberculosis was established based on the presence of Mycobacterium tuberculosis on the CSF molecular rapid test examination, and a CT scan of the head with contrast found cerebral tuberculoma.

References

Zubair AS, Landreneau M, Witsch J, Fulbright RK, Huttner A, Sheth KN, et al. A critically ill patient with central nervous system tuberculosis and negative initial workup. Frontiers in Neurology. 2020;11:1-3.

Krishnan V, Mittal MK, Sinha M, Kumar M, Thukral BB. Central nervous system tuberculosis: rare presentations of a common disease. Astrocyte. 2017;4(3):174-185.

Kumar EA, Bai PJ. A clinical study of CNS tuberculomas. IAIM. 2016;3(6):101-106.

Zunt JR. Tuberculosis of the central nervous system. Continuum. 2018;24(5):1422-1438.

Vinny PW, Vishnu VY. Tuberculous meningitis. Journal of Current Research in Scientific Medicine. 2019;5:13-22.

Bouchaud O, Mechal F. Tuberculous meningitis: challenges in diagnosis and management. Revue Neurologique. 2019;175:451-457.

Seddon JA, Tugume L, Solomons R, Prasad K, Bahr NC. The current global situation for tuberculous meningitis: epidemiology, diagnostics, treatment and outcomes.Welcome Open Research. 2019;4:1-15.

Shah IA, Asimi RP, Kawoos Y, Wani M, Sarmast AH. Tuberculomas of the brain with and without associated meningitis: a cohort of 28 cases treated with anti-tuberculosis drugs at a tertiary care centre. International Journal of Contemporary Medical Research. 2016;3(12):3484-3487.

Wilkinson RJ, Rohlwink U, Misra UK, Crevel RV, Mai NT, Dooley KE, et al. Tuberculous meningitis. Nat RFEv Neurol. 2017:13(10):581-598.

Seddon JA, Tugume L, Solomons R. The current global situation for tuberculous meningitis: epidemiology, diagnostics, treatment and outcomes. Welcome Open Research. 2019;4(167):1-15.

Kee CP, Periyasamy P, Law ZK, Ibrahim NM, Yahya WNNW, Mhadzir H, dkk. Features and prognostic factors of tuberculous meningitis. Infect Dis Epidemiol. 2017;3:028.

Wang M, Luo L, Zhang Y, Liu X, Liu L, He J. Treatment outcomes of tuberculous meningitis in adults: a systematic review and meta-analysis. BMC Pulm Med. 2019;19(1):200.

Chatterjee D, Radotra BD, Vasishta RK, Sharma K. Vascular complication of tuberculous meningitis. Neurol India. 2015;63:926-932.

Wang Y, Li Q, Zhen X, Liu Y, Wu Q. Imunologic cerebral vasculitis and extrapulmonary tuberculosis: an uncommon association. Journal of Clinical and Diagnostic Research. 2015;9(9):3-5.

WHO. Treatment of tuberculosis guidelines. WHO. 2010:130-160.

WHO. Guidelines for Treatment of drug susceptible tuberculosis and patient care. WHO. 2017:1-80.

Anderson NE, Somaratne J, Mason DF. Holland D, Thomas MG. Neurological and Systemic complications of tuberculous meningitis and its treatment at Auckland City Hospital, New Zealand. J Clin Neurosci. 2010;17(9):1114-1118.

Gu J, Xiao H, Wu F, Ge Y, Ma J, Sun W. Prognostic factor of tuberculous meningitis. Int J Clin Exp Med. 2015;8(3):4487-4493.


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