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Neurological Sciences
Published in: Neurological Sciences 9/2022

23-06-2022 | Tuberculosis | Original Article

Tuberculous myelitis: a prospective follow-up study

Authors: Mohd. Imran Khan, Ravindra Kumar Garg, Imran Rizvi, Hardeep Singh Malhotra, Neeraj Kumar, Amita Jain, Rajesh Verma, Praveen Kumar Sharma, Shweta Pandey, Ravi Uniyal, Parul Jain

Published in: Neurological Sciences | Issue 9/2022

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Abstract

Background

Prospective studies regarding tuberculous myelitis are lacking. We aimed to prospectively evaluate patients with tuberculous myelitis to identify the features that distinguish tuberculous myelitis from other myelitis.

Methods

This was a prospective study. Patients presenting with paraparesis/quadriparesis, and MRI showing myelitis were included. All patients were subjected to clinical, neuroimaging, and laboratory evaluation. Diagnosis of definite tuberculous myelitis was made if GeneXpert test in CSF was positive. Probable tuberculous myelitis was diagnosed if there was evidence of tuberculosis elsewhere in the body. Patients were treated with methylprednisolone and antituberculosis treatment. Patients were followed for 6 months. We compared the clinical, laboratory, and neuroimaging parameters and response to treatment of tuberculous myelitis with other myelitis. P values were adjusted using the Benjamini-Hochberg (BH) procedure to control false discovery rate.

Results

We enrolled 52 patients. Eighteen (34.6%) patients had tuberculous myelitis. Headache (P = 0.018) was significantly more common in tuberculous myelitis. The CSF protein (P < 0.001), and CSF cell count (P < 0.001) were significantly higher in tuberculous myelitis. On neuroimaging, a LETM was common in tuberculous myelitis. Spinal meningeal enhancement (14; 77.8%), extra-axial collection, and CSF loculation (6; 33.4%), arachnoiditis (3;16.7%), and concomitant spinal tuberculoma (2;11.1%) were other common imaging features of tuberculous myelitis. Tuberculous myelitis patients showed a better response (P = 0.025) to treatment.

Conclusion

Tuberculous myelitis was seen in approximately 35% of all myelitis cases, in a high tuberculosis endemic zone. Headache, markedly elevated CSF protein and spinal meningeal enhancement were distinguishing features. Tuberculous myelitis patients responded well to corticosteroids.
Literature
1.
Garg RK, Malhotra HS, Gupta R (2015) Spinal cord involvement in tuberculous meningitis. Spinal Cord 53(9):649–657CrossRef
2.
Wasay M, Arif H, Khealani B, Ahsan H (2006) Neuroimaging of tuberculous myelitis: analysis of ten cases and review of literature. J Neuroimaging Off J Am Soc Neuroimaging 16(3):197–205CrossRef
3.
Anonymous (1905) Myelitis and pulmonary tuberculosis. Hospital (Lond 1886) 9;38(986):359–360
4.
Rigdon RH (1947) Transverse myelitis accompanying tuberculous meningitis. Am Rev Tuberc 55(4):332–340PubMed
5.
Jorge de Saráchaga A, Rivera-Chávez LF, López-Martínez MS (2020) Neuromyelitis optica spectrum disorder (NMOSD) with hypothalamic involvement and central nervous system tuberculosis: a case report. Clin Neurol Neurosurg 193:105751
6.
Zhang Y, Zhu M, Wang L, Shi M, Deng H (2018) Longitudinally extensive transverse myelitis with pulmonary tuberculosis: two case reports. Medicine (Baltimore) 97(3):e9676CrossRef
7.
8.
Zayet S, Zaghdoudi A, Harrabi H, Goubantini A, Tiouiri BH (2021) Devic’s neuromyelitis optica associated with active pulmonary tuberculosis. Tunisia New Microbes New Infect 39:100828CrossRef
9.
Synmon B, Phukan P, Sharma SR, Hussain M (2021) Etiological and radiological spectrum of longitudinal myelitis: a hospital-based study in North East India. J Neurosci Rural Pract 12(4):739–744CrossRef
10.
Murphy KJ, Brunberg JA, Quint DJ, Kazanjian PH (1998) Spinal cord infection: myelitis and abscess formation. AJNR Am J Neuroradiol 19(2):341–348PubMedPubMedCentral
11.
Dutra BG, da Rocha AJ, Nunes RH, Maia ACM (2018) Neuromyelitis optica spectrum disorders: spectrum of MR imaging findings and their differential diagnosis. Radiogr Rev Publ Radiol Soc N Am Inc 38(1):169–93
12.
Singh AK, Malhotra HS, Garg RK, Jain A, Kumar N, Kohli N et al (2016) Paradoxical reaction in tuberculous meningitis: presentation, predictors and impact on prognosis. BMC Infect Dis 21(16):306CrossRef
13.
Uniyal R, Garg RK, Malhotra HS, Kumar N, Jain A, Kohli N et al (2019) Computed tomography thorax abnormalities in immunocompetent patients with tuberculous meningitis: an observational study. J Neurol Sci 15(397):11–15CrossRef
14.
Marais S, Thwaites G, Schoeman JF, Török ME, Misra UK, Prasad K et al (2010) Tuberculous meningitis: a uniform case definition for use in clinical research. Lancet Infect Dis 10(11):803–812CrossRef
15.
16.
Wingerchuk DM, Banwell B, Bennett JL, Cabre P, Carroll W, Chitnis T et al (2015) International consensus diagnostic criteria for neuromyelitis optica spectrum disorders. Neurology 85(2):177–189CrossRef
17.
Jarius S, Paul F, Aktas O, Asgari N, Dale RC, de Seze J et al (2018) MOG encephalomyelitis: international recommendations on diagnosis and antibody testing. J Neuroinflammation 3(15):134CrossRef
18.
Transverse Myelitis Consortium Working Group (2002) Proposed diagnostic criteria and nosology of acute transverse myelitis. Neurology 59(4):499–505CrossRef
19.
Garg RK, Malhotra HS, Kumar N (2014) Paradoxical reaction in HIV negative tuberculous meningitis. J Neurol Sci 340(1–2):26–36CrossRef
20.
21.
Lee SY, Kim DY, Sohn MK, Lee J, Lee SG, Shin YI et al (2020) Determining the cut-off score for the Modified Barthel Index and the Modified Rankin Scale for assessment of functional independence and residual disability after stroke. PLoS One 15(1):e0226324CrossRef
22.
Benjamini Y, Hochberg Y (1995) Controlling the false discovery rate: a practical and powerful approach to multiple testing. J R Stat Soc Ser B Methodol 57(1):289–300
23.
Gupta R, Garg RK, Jain A, Malhotra HS, Verma R, Sharma PK (2015) Spinal cord and spinal nerve root involvement (myeloradiculopathy) in tuberculous meningitis. Medicine (Baltimore) 94(3):e404CrossRef
24.
Jiang Y, Xu X, Guo Z, Liu Y, Lin J, Suo L et al (2022) Myelitis: a common complication of tuberculous meningitis predicting poor outcome. Front Neurol 13:830029CrossRef
25.
Zatjirua V, Butler J, Carr J, Henning F (2011) Neuromyelitis optica and pulmonary tuberculosis: a case-control study. Int J Tuberc Lung Dis Off J Int Union Tuberc Lung Dis 15(12):1675–1680CrossRef
26.
Trebst C, Raab P, Voss EV, Rommer P, Abu-Mugheisib M, Zettl UK et al (2011) Longitudinal extensive transverse myelitis–it’s not all neuromyelitis optica. Nat Rev Neurol 7(12):688–698CrossRef
27.
Mantese CE, Lubini R (2022) Froin’s syndrome with tuberculosis myelitis and spinal block. Rev Assoc Medica Bras 1992 68(1):10–2
28.
Purohit M, Mustafa T (2015) Laboratory diagnosis of extra-pulmonary tuberculosis (EPTB) in resource-constrained setting: state of the art, challenges and the need. J Clin Diagn Res JCDR 9(4):EE01–06
Metadata
Title
Tuberculous myelitis: a prospective follow-up study
Authors
Mohd. Imran Khan
Ravindra Kumar Garg
Imran Rizvi
Hardeep Singh Malhotra
Neeraj Kumar
Amita Jain
Rajesh Verma
Praveen Kumar Sharma
Shweta Pandey
Ravi Uniyal
Parul Jain
Publication date
23-06-2022
Publisher
Springer International Publishing
Published in
Neurological Sciences / Issue 9/2022
Print ISSN: 1590-1874
Electronic ISSN: 1590-3478
DOI
https://doi.org/10.1007/s10072-022-06221-6

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