Meningeal TB

From WebHealth

Meningeal TB

This is one of the most common presentations of TB among older people in the US who had been exposed to TB earlier in their lives. When a reactivation of the TB takes place there is a high fever coupled with an extreme headache. If not diagnosed, the symptoms will very quickly progress to drowsiness and coma. One of the complications can be thrombosis of one of the major blood vessels in the brain, which would mimic a stroke like picture. The neurologist can do a diagnostic lumbar puncture. This would show a glucose content of less than 50% of the serum glucose level, protein elevation and lymphocytic cells in the cerebrospinal fluid (CSF).

A commercial test using polymerase chain reaction to TB exists, which will be positive on this CSF sample. This test is rapid and specific for TB.

Anti-TB therapy using a multidrug combination chemotherapy as mentioned above can lead to a complete cure, provided the diagnosis was made early enough. Occasionally a brain abscess is found in the work-up of meningeal TB. A neurosurgeon should then be consulted to decide whether or not this should be removed while the patient is covered with antituberculous drug therapy. These cases and menigeal TB are more frequent among AIDS patients. There are also more TB brain abscess cases among IV drug users in recent years.

Infections overview

Respiratory infections

Tuberculosis table

References:

1. The Merck Manual, 7^th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 161.

2. TC Dixon et al. N Engl J Med 1999 Sep 9;341(11):815-826.

3. F Charatan BMJ 2000 Oct 21;321(7267):980.

4. The Merck Manual, 7^th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 43.

5. JR Zunt and CM Marra Neurol Clinics Vol.17, No.4,1999: 675-689.

6. The Merck Manual, 7^th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 162.

7. LE Chapman : Antivir Ther 1999; 4(4): 211-19.

8. HW Cho: Vaccine 1999 Jun 4; 17(20-21): 2569-2575.