Zhang Hayden, Hasan Tasnim, Dotel Ravindra, Ulbricht Evan, Gilroy Nicole, Maddocks Susan
Infectious Diseases Department, Blacktown Hospital, Blacktown, New South Wales, Australia.
School of Medicine, Western Sydney University, Blacktown, New South Wales, Australia.
Intern Med J. 2025 May;55(5):822-832. doi: 10.1111/imj.70017. Epub 2025 Mar 19.
Central nervous system tuberculosis (CNS-TB) is a rare complication of tuberculosis. There is a lack of data surrounding investigation and management of this in Australia.
To review CNS-TB cases in Western Sydney, Australia, and understand the epidemiology, investigation, diagnosis, management and outcomes in a low-prevalence setting.
Retrospective cohort study of all CNS-TB patients managed in Western Sydney from 2013 to 2022. Demographics, risk factors, clinical presentation, investigations and management were reviewed. Clinical outcomes like hospital length-of-stay, adverse drug reactions, paradoxical reactions, functional disability and treatment outcomes, including cure, treatment failure, loss to follow-up and death, were also measured.
Thirty-nine CNS-TB cases were identified, with 16 (41%) confirmed by nucleic acid amplification test or culture of CNS specimens and 23 (59%) diagnosed presumptively without CNS microbiological confirmation. The median age was 32 years. Thirty-seven (95%) were overseas-born; 27 (69%) had no comorbidities. Presenting symptoms included fever (82%), headache (64%) and weight loss (51%). Twenty-five (64%) used fluoroquinolones and nine (23%) used high-dose rifampicin. Steroids were used in all patients. Six (15%) were prescribed aspirin for primary stroke prevention. Twenty-eight (73%) completed treatment, with one requiring re-treatment for presumed treatment failure. Six (15%) were lost to follow-up, and five (13%) died during their treatment course. Twenty-one (54%) experienced an adverse drug reaction.
Tuberculosis is an ongoing public health issue in Australia, with CNS-TB being its most devastating form, and all clinicians to be aware of this rare complication. The efficacy of newer treatment options requires further study.
中枢神经系统结核（CNS-TB）是结核病的一种罕见并发症。在澳大利亚，围绕其调查与管理的数据匮乏。
回顾澳大利亚悉尼西部的中枢神经系统结核病例，了解低流行环境下的流行病学、调查、诊断、管理及结果。
对2013年至2022年在悉尼西部接受治疗的所有中枢神经系统结核患者进行回顾性队列研究。对人口统计学、危险因素、临床表现、检查及管理进行了回顾。还测量了住院时间、药物不良反应、矛盾反应、功能残疾及治疗结果（包括治愈、治疗失败、失访及死亡）等临床结局。
共确定39例中枢神经系统结核病例，其中16例（41%）通过中枢神经系统标本的核酸扩增试验或培养确诊，23例（59%）未经中枢神经系统微生物学确诊而被推定为诊断。中位年龄为32岁。37例（95%）出生于海外；27例（69%）无合并症。主要症状包括发热（82%）、头痛（64%）和体重减轻（51%）。25例（64%）使用氟喹诺酮类药物，9例（照23%）使用高剂量利福平。所有患者均使用了类固醇。6例（15%）因一级卒中预防而服用阿司匹林。28例（73%）完成治疗，其中1例因疑似治疗失败需要重新治疗。6例（15%）失访，5例（13%）在治疗过程中死亡。21例（54%）出现药物不良反应。
结核病在澳大利亚仍是一个持续存在的公共卫生问题，中枢神经系统结核是其最具破坏性的形式，所有临床医生都应意识到这种罕见并发症。新治疗方案的疗效需要进一步研究。
