1.Spinal tuberculous disease is common in tuberculous meningitis
Mei-Ling Sharon TAI ; Hazman Mohd NOR ; Shanthi VISWANATHAN ; Kartini RAHMAT ; Norzaini Rose Mohd Zain ; Zhen Yuan POW ; Lay Sim ONG ; Mohd Hanip RAFIA ; Chong Tin TAN
Neurology Asia 2017;22(4):313-323
Background: Tuberculous disease of spine (spinal TB) is under-recognized in tuberculous (TB) meningitis.The objective of the study was to evaluate the frequency, clinical and neuroimaging changes, andoutcome in the patients with spinal TB. Methods: All the patients with spinal TB admitted in the twolargest tertiary hospitals in Kuala Lumpur from 2009 to 2017 were recruited, the clinical features weredocumented, the magnetic resonance imaging (MRI) of the spine was performed. Clinical outcome wasassessed with Modified Rankin scale (MRS). Results: Twenty two patients were recruited. This wasout of 70 TB meningitis patients (31.4%) seen over the same period. Eighteen (81.8%) patients hadconcomitant TB meningitis. The clinical features consisted of systemic symptoms with fever (63.6%),meningitis symptoms with altered sensorium (45.5%), myelopathy with paraparesis (36.4%). Thefindings on spinal MRI were discitis (36.4%), spinal meningeal enhancement (31.8%), spinal cordcompression (31.8%), psoas abscess (27.3%), osteomyelitis (22.7%), and cord oedema (22.7%). Allexcept two patients (90.9%) had involvement in psoas muscle, bone or leptomeningeal enhancement,features that can be used to differentiate from myelopathy that affect the parenchyma only, such asdemyelination. Unusual manifestations were syringomyelia and paradoxical manifestations seen in 3patients each. The outcome were overall poor, with 68% having MRS 3 or more.Conclusion: Spinal TB is common in TB meningitis. The outcome is overall poor. A heightenedawareness is crucial to enable early diagnosis and treatment.
2.Neuroimaging findings are sensitive and specific in diagnosis of tuberculous meningitis
Mei-Ling Sharon Tai ; Hazman Mohd Nor ; Kartini Rahmat ; Shanthi Viswanathan ; Khairul Azmi Abdul Kadir ; Norlisah Ramli ; Fatimah Kamila Abu Bakar ; Norzaini Rose Mohd Zain ; Suhailah Abdullah ; Jun Fai Yap ; Ahmed Shaheed ; Boon Seng Ng ; Mohd Hanip Rafia ; Chong Tin Tan
Neurology Asia 2017;22(1):15-23
Objective: The primary objective of this study was to describe the neuroimaging changes of tuberculous
meningitis (TBM), and to determine the role of neuroimaging in the diagnosis of TBM. Methods:
Between January 2009 and July 2015, we prospectively recruited TBM patients in two hospitals in
Malaysia. Neuroimaging was performed and findings were recorded. The control consists of other types
of meningo-encephalitis seen over the same period. Results: Fifty four TBM patients were recruited.
Leptomeningeal enhancement was seen in 39 (72.2%) patients, commonly at prepontine cistern and
interpeduncular fossa. Hydrocephalus was observed in 38 (70.4%) patients, 25 (46.3%) patients had
moderate and severe hydrocephalus. Thirty four patients (63.0%) had cerebral infarction. Tuberculoma
were seen in 29 (53.7%) patients; 27 (50.0%) patients had classical tuberculoma, 2 (3.7%) patients
had “other” type of tuberculoma, 18 (33.3%) patients had ≥5 tuberculoma, and 11 (20.4%) patients
had < 5 tuberculoma. Fifteen (37.2%) patients had vasculitis, 6 (11.1%) patients had vasospasm. Close
to nine tenth (88.9%) of the patients had ≥1 classical neuroimaging features, 77.8% had ≥ 2 classical
imaging features of TBM (basal enhancement, hydrocephalus, basal ganglia / thalamic infarct, classical
tuberculoma, and vasculitis/vasospasm). Only 4% with other types of meningitis/encephalitis had ≥1
feature, and 1% had two or more classical TBM neuroimaging features. The sensitivity of the imaging
features of the imaging features for diagnosis of TBM was 88.9% and the specificity was 95.6%.
Conclusion: The classic imaging features of basal enhancement, hydrocephalus, basal ganglia/thalamic
infarct, classic tuberculoma, and vasculitis are sensitive and specific to diagnosis of TBM.
Tuberculosis, Meningeal
3.Updates on Knowledge, Attitude and Preventive Practices on Tuberculosis among Healthcare Workers
Farhanah Abd Wahab ; Sarimah Abdullah ; Jafri Malin Abdullah ; Hasnan Jaafar ; Siti Suraiya Md Noor ; Wan Mohd Zahiruddin Wan Mohammad ; Abdul Aziz Mohamed Yusoff ; John Tharakan ; Shalini Bhaskar ; Muthuraju Sangu ; Mohd Shah Mahmood ; Fauziah Kassim ; Md. Hanip Rafia ; Mohammed Safari Mohammed Haspani ; Azmi Alias ; Rogelio Hernández Pando
Malaysian Journal of Medical Sciences 2016;23(6):25-34
Ranking as the most communicable disease killer worldwide, tuberculosis, has accounted
with a total of 9.6 million new tuberculosis cases with 1.5 million tuberculosis-related deaths
reported globally in 2014. Tuberculosis has remain as an occupational hazard for healthcare
workers since 1920s and due to several tuberculosis outbreaks in healthcare settings in the early
1990s, the concern about the transmission to both patients and healthcare workers has been
raised. Healthcare workers have two to three folds greater the risk of active tuberculosis than the
general population. Several studies on knowledge, attitude and practices on tuberculosis among
healthcare workers worldwide have revealed that majority of the participated healthcare workers
had good knowledge on tuberculosis. Most of the healthcare workers from South India and South
Africa also reported to have positive attitude whereas a study in Thailand reported that most of
the healthcare providers have negative attitude towards tuberculosis patients. Nevertheless,
majority of the healthcare workers have low level of practice on tuberculosis prevention. An
improved communication between healthcare workers and the patients as well as their families
is the key to better therapeutic outcomes with good knowledge, attitude and preventive practice
towards tuberculosis.