Tuberculosis Research Today is a free monthly online journal that collates and summarizes the latest research about Tuberculosis, including details on symptoms, causes, treatment, pulmonary, mycobacterium. | ||||||||
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Tuberculous meningitis: protracted course and clinical response to interferon-gamma.Coulter JB, Baretto RL, Mallucci CL, Romano MI, Abernethy LJ, Isherwood DM, Kumararatne DS, Lammas DA Royal Liverpool Children's NHS Trust, Liverpool, UK. coulters@fulwood11.wanadoo.co.uk A 12-year-old girl with protracted tuberculous meningitis received standard chemotherapy and dexamethasone and had a progressive cerebrospinal fluid neutrophilia, raised protein and depressed glucose levels. Her temperature was raised for 5 months until a second course of dexamethasone was given. At week 15, multiple tuberculomas and hydrocephalus were detected followed by acute hydrocephalus (week 58), which required a ventricular-peritoneal shunt. Tuberculomas resolved after a second course of dexamethasone but recurred 15 months later. Immunological investigations were normal including integrity of the type 1 cytokine pathway. From month 24, interferon-gamma was given subcutaneously (initially 50 microg/m(2)) and continued for 19 months. Within 2 weeks she responded clinically followed by a reduction in inflammatory signs on magnetic resonance imaging scan (but not in the tuberculomas). At month 44, when chemotherapy was stopped, the cerebrospinal fluid/serum albumin quotient was 57x10(-3) (normal <6.0x10(-3)), which supports continuing major impairment of the blood-brain barrier. Gene expression in peripheral blood mononuclear cells before and during treatment with interferon-gamma, assessed by gene array analysis, showed reduction in a number of cytokine and chemokine genes. The response to interferon-gamma might have been secondary to downregulation of certain cytokine and chemokine genes. Published 23 February 2007 in Lancet Infect Dis, 7(3): 225-32.
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