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結核性髄膜炎の概説を提示したうえで,標準的治療に抵抗する病態などを取り上げた。具体的には初期悪化,脳結核腫,脳室炎,ヒト免疫不全ウイルス感染症合併の症例に対して,ステロイドパルス療法,イソニアジド髄腔内投与,免疫再構築症候群,薬剤耐性結核などを紹介した。本疾患は比較的稀だが,予後は依然として悪い場合も多く,難治性病態とその対応も把握することが望ましい。
Abstract
To understand tuberculous meningitis (TBM), its clinical features and standard therapy were briefly reviewed. In addition, to determine the therapeutic strategies for treatment-resistant TBM, several clinical cases, including those with paradoxical reaction, ventriculitis, cerebral tuberculoma, and human immunodeficiency virus (HIV) co-infection, are presented. Steroid pulse therapy and intrathecal isoniazid administration are discussed as specific therapeutic strategies. Immune reconstitution inflammatory syndrome in patients with TBM suffering from HIV co-infection and alternative drug selection for drug-resistant TBM cases are also introduced. Although TMB is a rare central nervous system infection, it remains a serious disease with high rates of mortality and neurological sequelae. Knowing therapeutic strategies for treatment-resistant TBM is necessary to prevent a devastating prognosis.
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