Tuberculoma

Tuberculoma

1. Tuberculoma - Ankit Kumar

2. Content Introduction Etiology Transmission Risk factor Sign & symptoms Diagnosis - CT, MRI Lab diagnosis Treatment

3. Introduction Tuberculoma or Tuberculous granulomas – Well defined focal masses that results from mycobacterium tuberculosis infection. One of severe morphological forms of tuberculosis. Most commonly occur in the brain and lungs. A Tuberculoma is a benign non-neoplastic mass (a tumor-like mass that is not a cancer) caused by a localized tuberculosis infection.

4. Etiology Mycobacterium tuberculosis Immuno compressed person By air droplets By exposure with person who is infected to prolonged

5. Transmission From person to person through the air Someone who’s sick cough, sneezed, talks, cough or sings, tiny droplets that contain the germ are released.

6. Risk factor 0.55% - 15% of systemic TB cases 1% intracranial Tuberculoma are seen I ntradural spinal tuberculomas – 2-5% of CNS tuberculomas Malnutrition Alcohol addiction Infant and children under 5yrs of age Smoking HIV

7. Sign &symptoms Headache/ vertigo Nausea/ Vomiting Weight loss Anorexia Fever Chills Night sweat Feeling tired at all time Stiff neck Blurry vision Confusion Spinal cord lesion Seizure Cranial nerve deficits Papilledema Meningismus

8. Diagnosis CT –scan :- Head Use ionizing radiation Done with contrast/ without contrast Suspicion of intracranial or intramedullary TB Immature lesions are hypodense and non-enhancing Many time findings are similar as CNS lesions, including fungal infections, neuro sarcoidosis, metastatic disease

9. CT

10. MRI Scan - Brain Use high magnetic field More specific and sensitive than CT. Done with or without contrast T1 weighted- Shows central iso-intensity T2 weighted – Shows the pathology Also mimic several of the aforementioned lesions.

11. MRI

12. Laboratory Test CSF fluid – lumbar puncture – 10-15 ml Show normal findings or have elevated protein, decreased glucose, or proteolysis. Always make AFB smear when testing CSF. Montoux test :- May be positive or negative WBC count:- male- 5000-10000/ml female - 5000-10000/ml RBC count :- Male - 4.5-5.5 *10 6 /ml female – 4-5 * 10 6 /ml Platelet count Male- 1.4 -4*10 5 /ml female – 1.4 - 4*10 5 /ml

13. ------ IGRA

14. IGRA ( Interferon gamma release Assay) Measure the immune response to mycobacterium tuberculosin. PCR ( Polymerase chain reaction) To detect TB antigen and the LEO-FM microscopy technique to identify TB antigen with microscopy may be used . Biopsy Done to see the histo-pathology of tissue. May show central necrosis, lymphocytes, Langerhans giant cells or epitheloid cells. No definitive diagnostic pathway is available for CNS TB.

15. Treatment Medication – Anti tuberculin drugs duration minimum doses 9 months 270 mg 4 months 120mg 3 months 12mg First line drug :- Isoniazid, rifampicin Second line drug :- caperomycin, amikacin Vaccination – BCG ( Bacillus calmette Guerin) DOTS ( Direct observed Therapy)

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