Management of intracranial tuberculous mass lesions : how long should we treat for? [version 3; peer review: 3 approved]

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dc.contributor.authorMarais, Suzaanen_ZA
dc.contributor.authorVan Toorn, Ronalden_ZA
dc.contributor.authorChow, Felicia C.en_ZA
dc.contributor.authorManesh, Abien_ZA
dc.contributor.authorSiddiqi, Omar K.en_ZA
dc.contributor.authorFigaji, Anthonyen_ZA
dc.contributor.authorSchoeman, Johan F.en_ZA
dc.contributor.authorMeintjes, Graemeen_ZA
dc.contributor.authorTuberculous Meningitis International Research Consortiumen_ZA
dc.date.accessioned2022-01-19T07:43:14Z
dc.date.available2022-01-19T07:43:14Z
dc.date.issued2019
dc.descriptionCITATION: 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.
dc.descriptionThe original publication is available at https://wellcomeopenresearch.org
dc.description.abstractENGLISH 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.en_ZA
dc.description.urihttps://wellcomeopenresearch.org/articles/4-158
dc.description.versionPublisher's version
dc.format.extent20 pagesen_ZA
dc.identifier.citationMarais, 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
dc.identifier.issn2398-502X (online)
dc.identifier.otherdoi:10.12688/wellcomeopenres.15501.3
dc.identifier.urihttp://hdl.handle.net/10019.1/124110
dc.language.isoen_ZAen_ZA
dc.publisherF1000Researchen_ZA
dc.rights.holderAuthors retain copyrighten_ZA
dc.subjectTuberculosis -- Treatmenten_ZA
dc.subjectIntracranial tuberculousen_ZA
dc.subjectTuberculosis -- Diagnosisen_ZA
dc.subjectCentral nervous systemen_ZA
dc.subjectTuberculosis -- Researchen_ZA
dc.subjectMeningitis, Tuberculousen_ZA
dc.titleManagement of intracranial tuberculous mass lesions : how long should we treat for? [version 3; peer review: 3 approved]en_ZA
dc.typeArticleen_ZA
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