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The diagnosis of brain tuberculoma by 1H-magnetic resonance spectroscopy

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Abstract

Toddlers are more prone to develop severe and extrapulmonary tuberculosis (TB) than older children. This is partially explained by differences in the immune response. Early and specific diagnosis is essential to start adequate treatment, especially if the central nervous system (CNS) is involved. The lack of sputum production and inherent dangers or impossibility of sampling CNS lesions may delay diagnosis. In addition, the magnetic resonance imaging (MRI) features of TB abscesses are non-specific and may mimic abscesses of other infectious etiology. 1H-magnetic resonance spectroscopy (1H-MRS) may increase specificity of diagnosis by identifying lipids within the lesions that are considered characteristic for TB. Therefore, we studied four children with presumable CNS-TB with MRI and 1H-MRS. In vivo and in vitro 1H-MRS showed elevated lipid peaks within the TB lesions. Conclusion: 1H-MRS allows to non-invasively identifying TB with high specificity and may allow early installment of targeted antimicrobial treatment.

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Acknowledgments

This study was made possible by the Kantha Bopha Foundation that is supported by donations mainly from Swiss people. The authors thank Dr. Ianina Scheer, Prof. Thierry .A. Huisman, and Prof. Beat Steinmann for helpful discussions.

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Authors and Affiliations

  1. Division of Pediatrics, Jayavarman VII Hospital, Kantha Bopha Children’s Hospital, Siem Reap, Cambodia

    Ky Santy, Phang Nan, Yay Chantana & Beat Richner

  2. Division of Pediatric Imaging, Jayavarman VII Hospital, Kantha Bopha Children’s Hospital, Siem Reap, Cambodia

    Ky Santy

  3. Division of Pediatric Laboratory Medicine and Microbiology, Jayavarman VII Hospital, Kantha Bopha Children’s Hospital, Siem Reap, Cambodia

    Denis Laurent

  4. Division of Infectious Diseases and Hospital Epidemiology, University Children’s Hospital of Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland

    David Nadal

  5. Pediatric Research Center (PRC), University Children’s Hospital of Zurich, Zurich, Switzerland

    David Nadal

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  1. Ky Santy
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  2. Phang Nan
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  3. Yay Chantana
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  4. Denis Laurent
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  5. David Nadal
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  6. Beat Richner
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Correspondence to Beat Richner.

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Santy, K., Nan, P., Chantana, Y. et al. The diagnosis of brain tuberculoma by 1H-magnetic resonance spectroscopy. Eur J Pediatr 170, 379–387 (2011). https://doi.org/10.1007/s00431-011-1408-7

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  • DOI: https://doi.org/10.1007/s00431-011-1408-7

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