Fever and headache are the cardinal features; confusion is a late feature and coma bears a poor prognosis. Meningism is absent in a fifth of patients with TB meningitis. Patients may also have focal neurological deficits.[1][5]
Causesedit
Mycobacterium tuberculosis of the meninges is the cardinal feature and the inflammation is concentrated towards the base of the brain.[6] When the inflammation is in the brain stem subarachnoid area, cranial nerve roots may be affected. The symptoms will mimic those of space-occupying lesions.[7]
Blood-borne spread certainly occurs, presumably by crossing the blood–brain barrier, but a proportion of patients may get TB meningitis from rupture of a cortical focus in the brain;[8] an even smaller proportion get it from rupture of a bony focus in the spine.[9]
Pathophysiologyedit
The pathophysiology of tuberculous meningitis involves bacterial invasion of the brain parenchyma meninges or cortex, causing the formation of small subpial foci. These foci, termed Rich foci, are necrotic and expand as the colonies within them multiply. Tubercle (focal) rupture in the subarachnoid space causes meningitis.[3]
Diagnosisedit
Tuberculous-meningitis-autopsy, showing associated brain oedema and congestion
Diagnosis of TB meningitis is made by analysing cerebrospinal fluid collected by lumbar puncture. When collecting CSF for suspected TB meningitis, a minimum of 1 ml of fluid should be taken (preferably 5 to 10 ml).[10] The CSF usually has a high protein, low glucose and a raised number of lymphocytes. Acid-fast bacilli are sometimes seen on a CSF smear, but more commonly, M. tuberculosis is grown in culture.[11] A spiderweb clot in the CSF that has been collected is rare but indicative of TB meningitis. ELISPOT testing is not useful for the diagnosis of acute TB meningitis and is often false negative,[12] but may paradoxically become positive after treatment has started, which helps to confirm the diagnosis.[citation needed]
Nucleic acid amplification tests (NAAT)edit
This is a group of tests that use polymerase chain reaction (PCR) to detect mycobacterial nucleic acid.[13] These test vary in which nucleic acid sequence they detect and vary in their accuracy. The two most common commercially available tests are the amplified mycobacterium tuberculosis direct test (MTD, Gen-Probe) and Amplicor.[14] In 2007, review concluded that for diagnosing tuberculous meningitis "Individually, the AMTD test appears to perform the best (sensitivity 74% and specificity 98%)", they found the pooled prevalence of TB meningitis to be 29%.[15]
The treatment of TB meningitis is isoniazid, rifampicin, pyrazinamide and ethambutol for two months, followed by isoniazid and rifampicin alone for a further ten months.[16] Steroids help reduce the risk of death in those without HIV.[17] Steroids can be used in the first six weeks of treatment,[18] A few people may require immunomodulatory agents such as thalidomide.[19]Hydrocephalus occurs as a complication in about a third of people with TB meningitis. The addition of aspirin may reduce or delay mortality, possibly by reducing complications such as cerebral infarctions.[20][21][22]
Referencesedit
^ abHarman RJ, Mason P (2002-01-01). Handbook of Pharmacy Healthcare: Diseases and Patient Advice. Pharmaceutical Press. p. 93. ISBN9780853695073.
^ abc"Meningitis - tuberculous: MedlinePlus Medical Encyclopedia". www.nlm.nih.gov. Retrieved 2015-06-02.
^ abGupta G, Taylor BE, Ramachandran TS (2018-05-23). Talavera F (ed.). "Tuberculous Meningitis: Background, Pathophysiology, Etiology". Medscape.
^. www.medilexicon.com. Archived from the original on 2016-05-13. Retrieved 2015-06-02.
^Leach RM (2010-06-11). Acute and Critical Care Medicine at a Glance. John Wiley & Sons. p. 101. ISBN9781444327229.
^Christodoulides M (2013). Meningitis: Cellular and Molecular Basis. CABI. p. 154. ISBN9781780641621.
^p1301 Robbins and Cotran, Pathologic Basis of Disease, 8th edition
^Nicoll JA, Bone I, Graham D (2006-11-24). Adams & Graham's Introduction to Neuropathology 3Ed. CRC Press. p. 127. ISBN9780340811979.
^"Cerebral spinal fluid (CSF) collection". MedlinePlus Medical Encyclopedia. U.S. National Library of Medicine. Retrieved 2015-06-02.
^Irani DN (2008). Cerebrospinal Fluid in Clinical Practice. Elsevier Health Sciences. p. 196. ISBN978-1416029083.
^Gram-Positive Bacterial Infections: Advances in Research and Treatment: 2011 Edition. ScholarlyEditions. 2012-01-09. p. 77. ISBN9781464929717.
^Takahashi T, Tamura M, Takasu T (2012). "The PCR-Based Diagnosis of Central Nervous System Tuberculosis: Up to Date". Tuberculosis Research and Treatment. 2012: 831292. doi:10.1155/2012/831292. PMC3359676. PMID 22666577.
^"CDC |TB | ...the Uses of Nucleic Acid Amplification Tests for the Diagnosis of TB: Background". www.cdc.gov. Retrieved 2015-06-02.
^Dinnes J, Deeks J, Kunst H, Gibson A, Cummins E, Waugh N, et al. (January 2007). "A systematic review of rapid diagnostic tests for the detection of tuberculosis infection". Health Technology Assessment. 11 (3): 1–196. doi:10.3310/hta11030. PMID 17266837.
^Barnett AH (2006). Diabetes: Best Practice & Research Compendium. Elsevier Health Sciences. p. 146. ISBN978-0323044011.
^Prasad K, Singh MB, Ryan H (April 2016). "Corticosteroids for managing tuberculous meningitis". The Cochrane Database of Systematic Reviews. 2016 (4): CD002244. doi:10.1002/14651858.cd002244.pub4. PMC4916936. PMID 27121755.
^Harrison J, Kulkarni K, Baguneid M, Prendergast B (2009). Oxford Handbook of Key Clinical Evidence. OUP Oxford. p. 336. ISBN9780199234073.
^Central Nervous System Bacterial Infections—Advances in Research and Treatment: 2012 Edition: ScholarlyBrief. ScholarlyEditions. 2012-12-26. p. 28. ISBN9781481616232.
^Rajshekhar V (2009). "Management of hydrocephalus in patients with tuberculous meningitis". Neurology India. 57 (4): 368–374. doi:10.4103/0028-3886.55572. PMID 19770534.
^Meningitis: New Insights for the Healthcare Professional: 2011 Edition: ScholarlyBrief. ScholarlyEditions. 2012-01-09. p. 2. ISBN9781464905292.
^Di Bella S, Luzzati R, Principe L, Zerbato V, Meroni E, Giuffrè M, et al. (January 2022). "Aspirin and Infection: A Narrative Review". Biomedicines. 10 (2): 263. doi:10.3390/biomedicines10020263. PMC8868581. PMID 35203473.
tuberculous, meningitis, also, known, meningitis, tubercular, meningitis, specific, type, bacterial, meningitis, caused, mycobacterium, tuberculosis, infection, meninges, system, membranes, which, envelop, central, nervous, system, other, namestb, meningitis, . Tuberculous meningitis also known as TB meningitis or tubercular meningitis is a specific type of bacterial meningitis caused by the Mycobacterium tuberculosis infection of the meninges the system of membranes which envelop the central nervous system 2 4 Tuberculous meningitisOther namesTB meningitis Tubercular meningitisCT scan showing tuberculous meningitisSpecialtyNeurology SymptomsFever 1 CausesMycobacterium tuberculosis 2 Diagnostic methodBlood culture CT scan 2 TreatmentAntibiotic therapy and corticosteroids 3 Contents 1 Signs and symptoms 2 Causes 3 Pathophysiology 4 Diagnosis 4 1 Nucleic acid amplification tests NAAT 5 Treatment 6 References 7 External linksSigns and symptoms editFever and headache are the cardinal features confusion is a late feature and coma bears a poor prognosis Meningism is absent in a fifth of patients with TB meningitis Patients may also have focal neurological deficits 1 5 Causes editMycobacterium tuberculosis of the meninges is the cardinal feature and the inflammation is concentrated towards the base of the brain 6 When the inflammation is in the brain stem subarachnoid area cranial nerve roots may be affected The symptoms will mimic those of space occupying lesions 7 Blood borne spread certainly occurs presumably by crossing the blood brain barrier but a proportion of patients may get TB meningitis from rupture of a cortical focus in the brain 8 an even smaller proportion get it from rupture of a bony focus in the spine 9 Pathophysiology editThe pathophysiology of tuberculous meningitis involves bacterial invasion of the brain parenchyma meninges or cortex causing the formation of small subpial foci These foci termed Rich foci are necrotic and expand as the colonies within them multiply Tubercle focal rupture in the subarachnoid space causes meningitis 3 Diagnosis edit nbsp Tuberculous meningitis autopsy showing associated brain oedema and congestionDiagnosis of TB meningitis is made by analysing cerebrospinal fluid collected by lumbar puncture When collecting CSF for suspected TB meningitis a minimum of 1 ml of fluid should be taken preferably 5 to 10 ml 10 The CSF usually has a high protein low glucose and a raised number of lymphocytes Acid fast bacilli are sometimes seen on a CSF smear but more commonly M tuberculosis is grown in culture 11 A spiderweb clot in the CSF that has been collected is rare but indicative of TB meningitis ELISPOT testing is not useful for the diagnosis of acute TB meningitis and is often false negative 12 but may paradoxically become positive after treatment has started which helps to confirm the diagnosis citation needed Nucleic acid amplification tests NAAT edit This is a group of tests that use polymerase chain reaction PCR to detect mycobacterial nucleic acid 13 These test vary in which nucleic acid sequence they detect and vary in their accuracy The two most common commercially available tests are the amplified mycobacterium tuberculosis direct test MTD Gen Probe and Amplicor 14 In 2007 review concluded that for diagnosing tuberculous meningitis Individually the AMTD test appears to perform the best sensitivity 74 and specificity 98 they found the pooled prevalence of TB meningitis to be 29 15 Treatment editSee also Tuberculosis treatment The treatment of TB meningitis is isoniazid rifampicin pyrazinamide and ethambutol for two months followed by isoniazid and rifampicin alone for a further ten months 16 Steroids help reduce the risk of death in those without HIV 17 Steroids can be used in the first six weeks of treatment 18 A few people may require immunomodulatory agents such as thalidomide 19 Hydrocephalus occurs as a complication in about a third of people with TB meningitis The addition of aspirin may reduce or delay mortality possibly by reducing complications such as cerebral infarctions 20 21 22 References edit a b Harman RJ Mason P 2002 01 01 Handbook of Pharmacy Healthcare Diseases and Patient Advice Pharmaceutical Press p 93 ISBN 9780853695073 a b c Meningitis tuberculous MedlinePlus Medical Encyclopedia www nlm nih gov Retrieved 2015 06 02 a b Gupta G Taylor BE Ramachandran TS 2018 05 23 Talavera F ed Tuberculous Meningitis Background Pathophysiology Etiology Medscape Tuberculous Meningitis Medical Definition www medilexicon com Archived from the original on 2016 05 13 Retrieved 2015 06 02 Leach RM 2010 06 11 Acute and Critical Care Medicine at a Glance John Wiley amp Sons p 101 ISBN 9781444327229 Christodoulides M 2013 Meningitis Cellular and Molecular Basis CABI p 154 ISBN 9781780641621 p1301 Robbins and Cotran Pathologic Basis of Disease 8th edition Nicoll JA Bone I Graham D 2006 11 24 Adams amp Graham s Introduction to Neuropathology 3Ed CRC Press p 127 ISBN 9780340811979 Behera D 2010 Textbook of Pulmonary Medicine Jaypee Brothers Publishers p 505 ISBN 9788184487497 permanent dead link Cerebral spinal fluid CSF collection MedlinePlus Medical Encyclopedia U S National Library of Medicine Retrieved 2015 06 02 Irani DN 2008 Cerebrospinal Fluid in Clinical Practice Elsevier Health Sciences p 196 ISBN 978 1416029083 Gram Positive Bacterial Infections Advances in Research and Treatment 2011 Edition ScholarlyEditions 2012 01 09 p 77 ISBN 9781464929717 Takahashi T Tamura M Takasu T 2012 The PCR Based Diagnosis of Central Nervous System Tuberculosis Up to Date Tuberculosis Research and Treatment 2012 831292 doi 10 1155 2012 831292 PMC 3359676 PMID 22666577 CDC TB the Uses of Nucleic Acid Amplification Tests for the Diagnosis of TB Background www cdc gov Retrieved 2015 06 02 Dinnes J Deeks J Kunst H Gibson A Cummins E Waugh N et al January 2007 A systematic review of rapid diagnostic tests for the detection of tuberculosis infection Health Technology Assessment 11 3 1 196 doi 10 3310 hta11030 PMID 17266837 Barnett AH 2006 Diabetes Best Practice amp Research Compendium Elsevier Health Sciences p 146 ISBN 978 0323044011 Prasad K Singh MB Ryan H April 2016 Corticosteroids for managing tuberculous meningitis The Cochrane Database of Systematic Reviews 2016 4 CD002244 doi 10 1002 14651858 cd002244 pub4 PMC 4916936 PMID 27121755 Harrison J Kulkarni K Baguneid M Prendergast B 2009 Oxford Handbook of Key Clinical Evidence OUP Oxford p 336 ISBN 9780199234073 Central Nervous System Bacterial Infections Advances in Research and Treatment 2012 Edition ScholarlyBrief ScholarlyEditions 2012 12 26 p 28 ISBN 9781481616232 Rajshekhar V 2009 Management of hydrocephalus in patients with tuberculous meningitis Neurology India 57 4 368 374 doi 10 4103 0028 3886 55572 PMID 19770534 Meningitis New Insights for the Healthcare Professional 2011 Edition ScholarlyBrief ScholarlyEditions 2012 01 09 p 2 ISBN 9781464905292 Di Bella S Luzzati R Principe L Zerbato V Meroni E Giuffre M et al January 2022 Aspirin and Infection A Narrative Review Biomedicines 10 2 263 doi 10 3390 biomedicines10020263 PMC 8868581 PMID 35203473 External links edit nbsp Scholia has a topic profile for Tuberculous meningitis Retrieved from https en wikipedia org w index php title Tuberculous meningitis amp oldid 1183555189, wikipedia, wiki, book, books, library,
