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  • Saraf DR - Steven - Meningitis TB

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    Tuberculous meningitis is the most common manifestation of tuberculous infection of the nervous system. It typically occurs years after a primary infection when bacteria spread from sites of infection to the meninges. Clinical features are staged from non-specific symptoms to confusion to coma. Investigations include cerebrospinal fluid analysis showing lymphocytic pleocytosis, low glucose, and high protein. Treatment involves a combination of antituberculous medications for 8-10 months, and steroids may be given if neurological signs worsen. Prognosis depends on stage at presentation, with advanced stages having poorer outcomes.

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    Tuberculous meningitis is the most common manifestation of tuberculous infection of the nervous system. It typically occurs years after a primary infection when bacteria spread from sites of infection to the meninges. Clinical features are staged from non-specific symptoms to confusion to coma. Investigations include cerebrospinal fluid analysis showing lymphocytic pleocytosis, low glucose, and high protein. Treatment involves a combination of antituberculous medications for 8-10 months, and steroids may be given if neurological signs worsen. Prognosis depends on stage at presentation, with advanced stages having poorer outcomes.

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    14 views10 pages

    Saraf DR - Steven - Meningitis TB

    Uploaded by

    xyros
    Tuberculous meningitis is the most common manifestation of tuberculous infection of the nervous system. It typically occurs years after a primary infection when bacteria spread from sites of infection to the meninges. Clinical features are staged from non-specific symptoms to confusion to coma. Investigations include cerebrospinal fluid analysis showing lymphocytic pleocytosis, low glucose, and high protein. Treatment involves a combination of antituberculous medications for 8-10 months, and steroids may be given if neurological signs worsen. Prognosis depends on stage at presentation, with advanced stages having poorer outcomes.

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    TUBERCULOUS MENINGITIS

    Dr. Steven, M.Si.Med, Sp.S

    Commonest manifestation of tuberculous


    infection of the nervous system
    In children : TB milier bacteraemia
    meningitis
    In adult
    :
    - occur many years after the primary
    infection
    - Following bacteraemia, metastatic foci of
    infection lodge in: meninges, cerebral or
    spinal tissue, choroid plexus
    - Rupture into the subarachnoid space
    (spontaneously or impaired immunity)

    Clinical features
    Stage 1 (early)

    Stage 2 (intermediate)

    Stage 3 (advanced)

    Non-specific symtoms

    Confusion

    Coma

    - Fever (in 80%)

    Cranial nerve pares is

    - Lethargy

    Meningism
    Vasculitis Hemiparesis
    Ataxia
    Dysarthria

    Staging is useful for predicting outcome

    Seizures may occur at the onset


    Involuntary movement (chorea, Myoclonus)
    occur in 10%
    Arachnoidit is inflammatory exudate may result in
    hydrocephalus

    Investigations
    General : anaemia, leucocytosis, hyponatraemia
    (if inappropriate ADH)
    Cerebrospinal f luid
    Xanthocrome, pellicle (+)
    Cell count is elevated, predominant ly
    lymphocytes
    Glucose is depressed (<50% blood sugar)
    Protein elevated
    Culture for M. tuberculosis (50
    (50--80% +)
    PCR

    Tuberculin skin t est


    Positive in 50% of cases
    Chest xx-ray
    infiltrate / cavitation / effusion / scar
    Ct scan and MRI (+ contrast)
    Hydrocephalus,
    basal meningeal thickening,
    infarct, oedema, tuberculoma

    Treatment
    Recomemended treatment programme:
    Normal regime:
    INH (300 mg daily)
    Rifampicin (600 mg daily)

    2 months

    INH
    Rifampicin

    6 months

    PZA (15-30 mg/kg daily)

    Drug resistance suspected due to previous antituberculous


    therapy, eg: - developing countries
    - history of previous inf ection
    Add a fourth drug streptomycin (1 g daily) or ethambutol
    (25 mg/kg daily)

    Antiturberculous Drug Penetrati on to CSF


    Drug

    Inflamed

    Non Inflamed

    Streptomicin

    Good

    Poor

    INH

    Good

    Good

    Rifampicin

    Good

    Poor

    Pyrazinamid

    Good

    Good

    Ethionamid

    Good

    Good

    Cycloserin

    Good

    Good

    Ethambutol

    Good

    Poor

    Side effects:
    - INH peripheral neuropathy pyridoxine 50
    mg daily
    - Ethambutol optic atrophy
    - Streptomysin 8th cranial nerve damage
    - All antituberculous drugs nausea, vomiting,
    abnormal liver function and skin rashes

    Steroid tend to be given when :


    - conscious level declines
    - neurological sign progress
    - Spinal block develops

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