Tuberculous brain abscesses in immunocompetent patients: management and outcome.
BACKGROUND
Tuberculosis (TB) remains an important public health problem in developing countries.


OBJECTIVE
To evaluate the clinical presentation, management, and long-term outcome in 6 patients with tuberculous brain abscesses (TBA), an uncommon form of central nervous system (CNS) TB.


METHODS
A search of medical records of a single referral neurological center in Mexico City from 2002 to 2007 retrieved 149 patients with CNS TB; 6 of them (4%) met Whitener's criteria for TBA and were included in this review.


RESULTS
Five of six patients had a previous history of TB. Three patients were referred to our center under antituberculous treatment (ATT) for pulmonary and lymph node TB, and two patients were receiving ATT for TB meningitis at diagnosis of TBA. All presented with symptoms of intracranial hypertension and hemiparesis. On imaging studies, 3 patients had a single, deep multiloculated lesion and another three had separated lesions, all patients underwent surgery and received long courses of ATT. One patient died after surgery and the rest recovered with moderate to severe neurological sequelae. The residual lesions in 5 patients resolved in follow-up CT or MRI studies at a mean time of 10 months.


CONCLUSIONS
Early surgery confirms the diagnosis of TBA. Some patients may require additional surgical procedures if enlargement or recurrence of the lesion occurs. No evidence of drug resistance was found in our cases, and we found only two reports of TBA with primary resistance to ATT in a selective literature review. TBA does not seem to be a consequence of drug resistance. Sequelae are common, and long-term ATT with close clinical and imaging follow-up is mandatory.
Cárdenas
Graciela
G
Department of Infectious Diseases, Instituto Nacional de Neurología y Neurocirugia Manuel Velasco Suárez, Insurgentes Sur 3877, Tlalpan CP. 14269, Mexico, D.F., Mexico. grace_goker@yahoo.de
Soto-Hernández
José Luis
JL
Orozco
Rosalba Vega
RV
Silva
Erik Guevara
EG
Revuelta
Rogelio
R
Amador
Juan Luis Gomez
JL
D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D001922:Brain Abscess / Q000175:diagnosis / Q000628:therapy; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000472:pathogenicity*; D012189:Retrospective Studies; D016896:Treatment Outcome; D020306:Tuberculosis, Central Nervous System / Q000175:diagnosis* / Q000628:therapy*; D055815:Young Adult
D000995:Antitubercular Agents