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Thalidomide works against central nervous system TB-related complications

19 Dec 2020

Use of low-dose thalidomide in the adjunctive setting is beneficial in the treatment of paediatric patients who developed enlarging tuberculosis (TB) abscesses with a tolerable safety profile, a study has found.

The analysis was based on a retrospective cohort of 38 children (median age, 33 months; 20 boys) consecutively treated with adjunctive thalidomide for CNS TB-related complications over a 10-year period. Eight of the children (21.1 percent) were HIV-infected.

Most children presented with focal motor deficit (n=16), while others had cranial nerve palsies and signs of cerebellar dysfunction. Large dural-based lesions were detected in three children, blindness secondary to optochiasmatic arachnoiditis occurred in four children, and paraplegia due to spinal cord TB mass lesions in two children. All of those with HIV infection were severely immunocompromised at the onset of the TB disease, with a median CD4 percentage of 19.6 percent.

Adjunctive thalidomide therapy was given at 3-5 mg/kg/day, with duration varying according to complication type. Children compromised by TB mass lesions received treatment for a median of 3.9 months, whereas those with optic neuritis were treated for a median of 2.0 months.

All children showed satisfactory clinical and radiological responses, except for a single HIV-uninfected child with stage 3 drug-susceptible tuberculous meningitis who died. The reason for death was brainstem ischemia due to progressive TB-related vasculitis.

None of the children developed rashes, hepatitis, hematologic derangements, or complained of leg cramps.

The findings require further investigation into the potential role of thalidomide or analogues in the treatment of other TB-related complications.

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Most Read Articles
01 Dec 2020
Tetanus toxoid 5 Lf, diphtheria toxoid 2 Lf, pertussis toxoid 2.5 mcg, filamentous haemagglutinin 5 mcg, fimbriae types 2 and 3 5 mcg, pertactin 3 mcg
Dr. Hsu Li Yang, Dr. Tan Thuan Tong, Dr. Andrea Kwa, 08 Jan 2021
Antimicrobial resistance has become increasingly dire as the rapid emergence of drug resistance, especially gram-negative pathogens, has outpaced the development of new antibiotics. At a recent virtual symposium, Dr Hsu Li Yang, Vice Dean (Global Health) and Programme Leader (Infectious Diseases), NUS Saw Swee Hock School of Public Health, presented epidemiological data on multidrug-resistant (MDR) gram-negative bacteria (GNB) in Asia, while Dr Tan Thuan Tong, Head and Senior Consultant, Department of Infectious Diseases, Singapore General Hospital (SGH), focused on the role of ceftazidime-avibactam in MDR GNB infections. Dr Andrea Kwa, Assistant Director of Research, Department of Pharmacy, SGH, joined the panel in an interactive fireside chat, to discuss challenges, practical considerations, and solutions in MDR gram-negative infections. This Pfizer-sponsored symposium was chaired by Dr Ng Shin Yi, Head and Senior Consultant of Surgical Intensive Care, SGH.
Jairia Dela Cruz, 4 days ago
Spending too much time sitting cannot be good for the body, and rising to one's feet breaks up such a behaviour and yields small, but meaningful, reductions in certain cardiovascular disease (CVD) risk factors, according to the results of a meta-analysis.
4 days ago
Use of thyroid hormone therapy does not seem to protect older adults with subclinical hypothyroidism against mortality, but it appears to confer survival benefits to those aged <65 years, results of a study have shown.