Tuberculous meningitis

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
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Tuberculous meningitis
Synonyms	N/A
Pronounce	N/A
Specialty	N/A
Symptoms	Headache, fever, neck stiffness, confusion, vomiting
Complications	Hydrocephalus, stroke, seizures
Onset	Gradual
Duration	Weeks to months
Types	N/A
Causes	Mycobacterium tuberculosis
Risks	HIV/AIDS, immunosuppression, malnutrition
Diagnosis	Lumbar puncture, CSF analysis, MRI
Differential diagnosis	Bacterial meningitis, viral meningitis, fungal meningitis
Prevention	BCG vaccine, tuberculosis control
Treatment	Antitubercular therapy, corticosteroids
Medication	Isoniazid, rifampicin, pyrazinamide, ethambutol
Prognosis	Variable, depends on stage at diagnosis
Frequency	More common in developing countries
Deaths	High if untreated

Autopsy findings in tuberculous meningitis

Tuberculous meningitis is a form of meningitis caused by Mycobacterium tuberculosis, the bacterium responsible for tuberculosis. It is a serious condition that affects the meninges, the protective membranes covering the brain and spinal cord.

Signs and Symptoms

The symptoms of tuberculous meningitis can develop gradually over several weeks. Early symptoms may include fever, headache, nausea, and vomiting. As the disease progresses, patients may experience neck stiffness, confusion, seizures, and coma.

Pathophysiology

Tuberculous meningitis occurs when Mycobacterium tuberculosis spreads from the lungs to the central nervous system. The bacteria can enter the bloodstream and reach the meninges, causing inflammation and the formation of tuberculomas. This inflammation can lead to increased intracranial pressure and hydrocephalus.

Diagnosis

Diagnosis of tuberculous meningitis is challenging and often requires a combination of clinical assessment, cerebrospinal fluid (CSF) analysis, and imaging studies such as MRI or CT scan. CSF analysis typically shows elevated protein levels, low glucose levels, and a high white blood cell count with a predominance of lymphocytes.

Treatment

The treatment of tuberculous meningitis involves a prolonged course of antitubercular therapy (ATT), which includes drugs such as isoniazid, rifampicin, pyrazinamide, and ethambutol. Corticosteroids may also be used to reduce inflammation and prevent complications.

Prognosis

The prognosis of tuberculous meningitis depends on the stage at which treatment is initiated. Early diagnosis and treatment are crucial for a favorable outcome. Delayed treatment can lead to severe neurological damage or death.

Epidemiology

Tuberculous meningitis is more common in regions with high rates of tuberculosis, such as sub-Saharan Africa and Southeast Asia. It is also more prevalent in individuals with HIV/AIDS due to their compromised immune systems.

See also

• Tuberculosis
• Meningitis
• Central nervous system