Management of intracranial tuberculous mass lesions : how long should we treat for? [version 3; peer review: 3 approved]
Date
2019
Journal Title
Journal ISSN
Volume Title
Publisher
F1000Research
Abstract
ENGLISH ABSTRACT: Tuberculous intracranial mass lesions are common in settings with
high tuberculosis (TB) incidence and HIV prevalence. The diagnosis such lesions, which include
tuberculoma and tuberculous abscesses, is often presumptive and based on radiological features,
supportive evidence of TB elsewhere and response to TB treatment. However, the treatment response
is unpredictable, with lesions frequently enlarging paradoxically or persisting for many years
despite appropriate TB treatment and corticosteroid therapy. Most international guidelines
recommend a 9-12 month course of TB treatment for central nervous system TB when the infecting
Mycobacterium tuberculosis (M.tb) strain is sensitive to first-line drugs. However, there is
variation in opinion and practice with respect to the duration of TB treatment in patients with
tuberculomas or tuberculous abscesses. A major reason for this is the lack of prospective clinical
trial evidence. Some experts suggest continuing treatment until radiological resolution of
enhancing lesions has been achieved, but this may unnecessarily expose patients
to prolonged periods of potentially toxic drugs. It is currently unknown whether persistent radiological enhancement of intracranial tuberculomas after 9-12 months
of treatment represents active disease, inflammatory response in a sterilized lesion or merely
revascularization. The consequences of stopping TB treatment prior to resolution of lesional
enhancement have rarely been explored. These important issues were discussed at the 3rd
International Tuberculous Meningitis Consortium meeting. Most clinicians were of the opinion that
continued enhancement does not necessarily represent treatment failure and that prolonged TB
therapy was not warranted in patients presumably infected with M.tb strains susceptible to
first-line drugs. In this manuscript we highlight current medical treatment practices, benefits and
disadvantages of different TB treatment durations and the need for evidence-based guidelines
regarding the treatment duration of patients with intracranial tuberculous mass
lesions.
Description
CITATION: Marais, S., et al. 2019. Management of intracranial tuberculous mass lesions : how long should we treat for? [version 3; peer review: 3
approved]. Wellcome Open Research, 4:158, doi:10.12688/wellcomeopenres.15501.3.
The original publication is available at https://wellcomeopenresearch.org
The original publication is available at https://wellcomeopenresearch.org
Keywords
Tuberculosis -- Treatment, Intracranial tuberculous, Tuberculosis -- Diagnosis, Central nervous system, Tuberculosis -- Research, Meningitis, Tuberculous
Citation
Marais, S., et al. 2019. Management of intracranial tuberculous mass lesions : how long should we treat for? [version 3; peer review: 3
approved]. Wellcome Open Research, 4:158, doi:10.12688/wellcomeopenres.15501.3