Central Nervous System Complications in Miliary Pulmonary Tuberculosis: A Systematic Review Of Published Case Reports And Case Series

BackgroundThis systematic review aims to evaluate central nervous system involvement in context of miliary pulmonary tuberculosis. MethodsWe included studies on central nervous system infections associated with miliary pulmonary tuberculosis involving human subjects in any language. Patients with disseminated tuberculosis involving two non-contiguous organs were excluded. Databases searched included PubMed, Scopus, Embase, and Google Scholar. Case reports, case series, and observational studies with confirmed diagnoses were included. The review follows PRISMA guidelines and is registered with PROSPERO (CRD42024542130). ResultsThe review included 158 records describing 161 patients. The mean age was 32.7 years, with 53.4% females. Key comorbid conditions included human immunodeficiency virus positivity (6.8%), immunosuppressive therapy (9.9%), and chronic kidney disease (2.5%). Common clinical features were fever (58.4%), headache or vomiting (41.6%), and altered sensorium (26.7%). Frequent neuroimaging abnormalities were miliary or multiple brain tuberculomas (66.5%), basal exudates (7.5%), vertebral tuberculosis (7.5%), cerebral infarcts (6.8%), and spinal cord tuberculoma or abscess (6.2%). Paradoxical manifestations occurred in one-third of cases, including new or enlarged brain lesions (22.4%) and paradoxical cerebral infarcts (2.5%). Cerebrospinal fluid findings were normal or unavailable in 45.3% of cases. Positive diagnostic tests included smear, culture, polymerase chain reaction, or GeneXpert in 25% of cases, with 5% showing drug resistance. Improvement was seen in 80.8% of patients, while 9.9% either died or did not improve. ConclusionThis review highlights diverse central nervous system involvement in miliary pulmonary tuberculosis, including tuberculous meningitis and spinal cord lesions, with common paradoxical manifestations and significant patient improvement with following treatment.