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Meningitis - tuberculous

Tubercular meningitis; TB meningitis

 

Tuberculous meningitis is an infection of the tissues covering the brain and spinal cord (meninges).

Causes

 

Tuberculous meningitis is caused by Mycobacterium tuberculosis. This is the bacteria that causes tuberculosis (TB). The bacteria spread to the brain and spine from another place in the body, usually the lung.

Tuberculous meningitis is very rare in the United States. Most cases are people who traveled to the United States from other countries where TB is common.

People who have the following have a higher chance of developing tuberculous meningitis:

  • HIV/AIDS
  • Drink alcohol in excess
  • TB of the lung
  • Weakened immune system

 

Symptoms

 

The symptoms often start slowly, and may include:

  • Fever and chills
  • Mental status changes
  • Nausea and vomiting
  • Sensitivity to light (photophobia)
  • Severe headache
  • Stiff neck (meningismus)

Other symptoms that can occur with this disease may include:

  • Agitation
  • Bulging fontanelles (soft spots) in babies
  • Decreased consciousness
  • Poor feeding or irritability in children
  • Unusual posture, with the head and neck arched backward (opisthotonos). This is usually found in infants. 

 

Exams and Tests

 

The health care provider will examine you. This will usually show that you have the following:

  • Fast heart rate
  • Fever
  • Mental status changes
  • Stiff neck

A lumbar puncture (spinal tap) is an important test in diagnosing meningitis. It is done to collect a sample of spinal fluid for examination. More than one sample may be needed to make the diagnosis.

Other tests that may be done include:

  • Biopsy of the brain or meninges
  • Blood culture
  • Chest x-ray
  • CSF examination for cell count, glucose, and protein
  • CT scan of the head
  • Gram stain, other special stains, and culture of CSF
  • Polymerase chain reaction (PCR) of CSF
  • Skin test for TB (PPD)
  • Other tests to look for TB

 

Treatment

 

You will be given several medicines to fight the TB bacteria. Sometimes, treatment is started even if your provider thinks you have the disease, but testing has not confirmed it yet.

Treatment usually lasts for at least 12 months. Medicines called corticosteroids may also be used.

 

Outlook (Prognosis)

 

Tuberculous meningitis is life threatening if untreated. Long-term follow-up is needed to detect repeated infections (recurrences).

 

Possible Complications

 

Untreated, the disease can cause any of the following:

  • Brain damage
  • Build-up of fluid between the skull and brain (subdural effusion)
  • Hearing loss
  • Hydrocephalus (buildup of fluid inside the skull that leads to brain swelling)
  • Seizures

 

When to Contact a Medical Professional

 

Call the local emergency number (such as 911) or go to an emergency room if you suspect meningitis in a young child who has the following symptoms:

  • Feeding problems
  • High-pitched cry
  • Irritability
  • Persistent unexplained fever

Call the local emergency number if you develop any of the serious symptoms listed above. Meningitis can quickly become a life-threatening illness.

 

Prevention

 

Treating people who have signs of a non-active (dormant) TB infection can prevent its spread. A PPD test and other TB tests can be done to tell if you have this type of infection.

Some countries with a high incidence of TB give people a vaccine called BCG to prevent TB. But, the effectiveness of this vaccine is limited, and it is not usually used in the United States. The BCG vaccine may help prevent severe forms of TB, such as meningitis, in very young children who live in areas where the disease is common.

 

 

References

Anderson NC, Koshy AA, Roos KL. Bacterial, fungal and parasitic diseases of the nervous system. In: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; 2016:chap 79.

Cruz AT, Starke JR. Tuberculosis. In: Cherry JD, Harrison GJ, Kaplan SL, Steinbach WJ, Hotez PJ, eds. Feigin and Cherry's Textbook of Pediatric Infectious Diseases. 7th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 96.

Fitzgerald DW, Sterling TR, Haas DW. Mycobacterium tuberculosis. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, Updated Edition. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 251.

Thwaites GE, van Toorn R, Schoeman J. Tuberculous meningitis: more questions, still too few answers. Lancet Neurol. 2013;12(10):999-1010. PMID: 23972913 www.ncbi.nlm.nih.gov/pubmed/23972913.

 
  • Central nervous system

    Central nervous system - illustration

    The central nervous system is comprised of the brain and spinal cord. The peripheral nervous system includes all peripheral nerves.

    Central nervous system

    illustration

    • Central nervous system

      Central nervous system - illustration

      The central nervous system is comprised of the brain and spinal cord. The peripheral nervous system includes all peripheral nerves.

      Central nervous system

      illustration

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        Review Date: 11/27/2016

        Reviewed By: Arnold Lentnek, MD, Infectious Diseases Medical Practice of NY and Clinical Research Centers of CT. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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