Meningitis - tuberculous

Definition

Tuberculous meningitis is an infection of the meninges (membranes covering the brain and spinal cord). It is caused by the bacteria that causes tuberculosis, Mycobacterium tuberculosis.

Causes, incidence, and risk factors

Tuberculous meningitis is caused by spread of Mycobacterium tuberculosis from another site in the body. The symptoms usually begin gradually. Risk factors include a history of pulmonary tuberculosis, excessive alcohol use, AIDS, or other disorders that compromise the immune system.

Tuberculous meningitis is a very rare disorder.

Symptoms

• Seizures
• Fever
• Listlessness
• Loss of appetite
• Severe headache
• Nausea and vomiting
• Stiff neck
• Sensitivity to light (photophobia)
• Loss of consciousness

Signs and tests

For any patient with meningitis, it is important to perform a lumbar puncture (spinal tap), where a needle is inserted into the back of the patient and spinal fluid (known as cerebrospinal fluid, or CSF) is sampled. The following tests help diagnose tuberculous meningitis:

• Spinal fluid (CSF) stain positive for mycobacterium
• CSF with high protein, low glucose and increased lymphocytes
• CSF culture growing M. tuberculosis
• CSF positive for M. tuberculosis PCR
• Positive skin test for tuberculosis
• Brain or meningeal biopsy showing M. tuberculosis

Treatment

Treatment involves use of antitubercular drugs as for pulmonary tuberculosis. Systemic steroids may also be used.

Expectations (prognosis)

Tuberculous meningitis is fatal if untreated. Long-term follow up is necessary to detect recurrences.

Complications

Residual brain damage may cause motor paralysis, convulsions, mental impairment, and abnormal behavior.

Calling your health care provider

Go to the emergency room or call 911 if you suspect you or your child may have any form of meningitis. This condition can rapidly cause disability or death.

Call your health care provider if symptoms worsen or do not improve with treatment, or if new symptoms develop.

Prevention

In areas where tuberculosis is more common, the BCG vaccine may help prevent severe forms of tuberculosis, such as meningitis, in very young children. Otherwise, the spread of tuberculosis can be prevented by treating people who have evidence of a dormant tuberculosis infection, as evidenced by a positive PPD.

Illustrations

Central nervous system

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