Spectrum of Neurotuberculosis and Analysis of outcome of treatment with RNTCP Dots Regimen.

Uma Maheswari, E (2013) Spectrum of Neurotuberculosis and Analysis of outcome of treatment with RNTCP Dots Regimen. Masters thesis, Madras Medical College, Chennai.


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Tuberculosis is an infectious disease producing a major global health problem worldwide. The incidence rate of tuberculosis in India is very high and accounts for one third of global cases. Annually about 8 million individuals around the world develop TB and 70,000 of these patients acquire TB meningitis. In immune competent individuals, CNS tuberculosis accounts for about 1% of all cases of tuberculosis and 6% of extra pulmonary tuberculosis. The occurrence of neurotuberculosis goes hand in hand with the incidence of TB infection in the general population . Ten percentage of all patients with tuberculosis have been estimated to have CNS involvement2. The various manifestations of neurotuberculosis is included under three major clinical categories: meningitis, tuberculoma brain, spinal tuberculous arachnoiditis. The Revised National Tuberculosis Control Programme (RNTCP) of Government of India based on universally recommended ‘directly observed treatment short-course’ (DOTS) therapy was launched in 1997. DOTS therapy in tuberculosis is the standardized treatment of TB patients in India. RNTCP is the largest and the fastest expanding programme in the world. In India more than 11 million patients have been treated since the inception of the RNTCP. CONCLUSION : (1) The spectrum of illness of neurotuberculosis affects younger individuals in the age group of 20 to 29 and has a male preponderance. (2) The most common type of presentation of neurotuberculosis is tuberculous meningitis and the common symptom is fever and head ache. The most common manifestation of tuberculoma is seizures. (3) TBM patients present in the advanced stage ( stage 2 and stage 3) of the illness. (4) The most common complication of TBM is hydrocephalus and the most devastating complication of neurotuberculosis is visual impairment due to optochiasmatic arachanoiditis. (5) CSF proteins correlated with clinical severity of illness and it can used to prognosticate the adverse outcome. (6) Twenty two percentage of those who had hydrocephalus underwent surgical intervention like ventriculoperitonel shunting . The outcome of surgical intervention is disappointing with deaths occurring in one third, treatment failure in one third, and one third left back with severe neurological sequlae. (7) The outcome of mangement with the standard RNTCP DOTS regimen was that a success rate (treatment completed ) of 75%, default rate of 6.6%, mortality rate of 3.3% was obtained. The target fixed by the RNTCP is to achieve a cure rate of 85%.We were able to document a successful completion of treatment in 75% which is close to the target fixed by RNTCP. The default rate is 6.6% which quite negligible when compared to the unsupervised therapy which has a default rate of 50%. (8) Early diagnosis of neurological TB is important because, the timing of initiation of antituberculosis treatment is the most important variable for predicting the outcome in these patients. A high index of clinical suspicion coupled with a battery of imaging and CSF laboratory investigations are required to confirm the diagnosis as it is exceptionally difficult to ascertain histopathological / microbiological proof.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Spectrum of Neurotuberculosis ; Analysis of outcome of treatment ; Revised National Tuberculosis Control Programme ; RNTCP ; Dots Regimen.
Subjects: MEDICAL > Neurology
Depositing User: Kambaraman B
Date Deposited: 30 Jun 2017 02:38
Last Modified: 30 Jun 2017 05:29
URI: http://repository-tnmgrmu.ac.in/id/eprint/660

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