Clinical approach to drug-resistant tuberculosis of the brain and spine in a low-income setting: A case series
Abstract
Background: Drug-resistant tuberculosis (TB) of the brain and spine is difficult to sample for culture. It poses a significant challenge to physicians in low- and middle-income countries.
Methods: We present three patients of drug-resistant tuberculosis and demonstrate how we manage them in limited resources.
Case series: Multi drug-resistant (MDR1): a young female patient had cerebellar tuberculomas at presentation. While being on conventional antituberculous therapy (ATT), she developed meningitis, and deteriorated with impaired conscious-level. Later, patient sustained ischemic strokes. Second-line ATT improved her condition. Treatment course was complicated by peripheral neuropathy, and psychotic behavior.MDR2, a middle-aged woman having type-II diabetes was diagnosed with lumbar spondylitis. She was on conventional ATT for 1 year. Severe backache relapsed within a month of discontinuation of treatment. We started her on empirical second-line treatment. She had a dramatic response in pain and completely recovered at 1 year.MDR3, a middle-aged woman had spondylitic changes at D10-D11 vertebral bodies on magnetic resonance imaging. The pain showed sub-optimum response to conventional ATT. The hyperintense signal changes resolved at 1 year of treatment with levofloxacin and linezolid.
Conclusion: These outcomes will raise physicians' awareness of the need for early suspicion, and timely initiation of second-line therapy.
How strong is the evidence?
Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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