Chapter 73 - Tuberculosis

Summary

This chapter presents the epidemiology, clinical features, diagnosis and principles of the management for tuberculosis. History of contact with and the presence of pulmonary tuberculosis on chest X-ray are more often found in children than in adults. Children less often complain of headache and more often have hydrocephalus. The tuberculin skin test and its immunological equivalent with blood, the interferon-gamma releasing assay (IGRA) which measures interferon-gamma release by T cells, both measure development of cell-mediated immunity after exposure to Mycobacterium tuberculosis. Neurotuberculosis is associated with an increased risk of epilepsy. Risk of epilepsy is higher if there were early seizures and particularly status epilepticus. The differential diagnosis includes all other causes of central nervous system (CNS) infection, bacterial meningitis, viral meningoencephalitis, cerebral malaria, fungal meningitis, and even non-infective causes. The first-line antiepileptic drugs (AEDs), phenytoin, carbamazepine, valproate, and phenobarbitone, are most widely used in developing countries.