Tuberculous meningitis

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Tuberculous meningitis
Other namesTB meningitis, Tubercular meningitis
CT scan showing tuberculous meningitis
SpecialtyNeurology Edit this on Wikidata
SymptomsFever[1]
CausesMycobacterium tuberculosis[2]
Diagnostic methodBlood culture, CT scan[2]
TreatmentAntibiotic therapy and corticosteroids[3]

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]

Signs and symptoms

See also: Chronic meningitis

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]

Causes

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

The pathophysiology of tuberculous meningitis involves bacterial invasion of the brain

subarachnoid space causes meningitis.[3]

Diagnosis

Tuberculous-meningitis-autopsy, showing associated brain oedema and congestion

Diagnosis of TB meningitis is made by analysing

ELISPOT testing is not useful for the diagnosis of acute TB meningitis and is often false negative,[13] but may paradoxically become positive after treatment has started, which helps to confirm the diagnosis.[citation needed
]

Nucleic acid amplification tests (NAAT)

This is a group of tests that use polymerase chain reaction (PCR) to detect mycobacterial nucleic acid.[14] 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.[15] 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%.[16] The fully automated PCR test using the Cepheid GeneXpert system of the Xpert Ultra MTB/RIF has improved sensitivity of up to 77% in persons with HIV and TB meningitis.[17]

Treatment

See also:
Tuberculosis treatment

The treatment of TB meningitis is

immunomodulatory agents such as thalidomide.[21] 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.[22][23][24]

References

  1. ^
    ISBN 9780853695073
    .
  2. ^ a b c "Meningitis - tuberculous: MedlinePlus Medical Encyclopedia". www.nlm.nih.gov. Retrieved 2015-06-02.
  3. ^ a b Gupta G, Taylor BE, Ramachandran TS (2018-05-23). Talavera F (ed.). "Tuberculous Meningitis: Background, Pathophysiology, Etiology". Medscape.
  4. ^ "Tuberculous Meningitis -- Medical Definition". www.medilexicon.com. Archived from the original on 2016-05-13. Retrieved 2015-06-02.
  5. ISBN 9781444327229
    .
  6. ISBN 9781780641621
    .
  7. ^ p1301 Robbins and Cotran, Pathologic Basis of Disease, 8th edition
  8. ISBN 9780340811979
    .
  9. ISBN 9788184487497.[permanent dead link
    ]
  10. ^ "Cerebral spinal fluid (CSF) collection". MedlinePlus Medical Encyclopedia. U.S. National Library of Medicine. Retrieved 2015-06-02.
  11. PMID 26459535
    .
  12. ISBN 978-1416029083
    .
  13. ISBN 9781464929717
    .
  14. PMID 22666577
    .
  15. ^ "CDC |TB | ...the Uses of Nucleic Acid Amplification Tests for the Diagnosis of TB: Background". www.cdc.gov. Retrieved 2015-06-02.
  16. PMID 17266837
    .
  17. PMID 31924549
    .
  18. ISBN 978-0323044011
    .
  19. PMID 27121755
    .
  20. ISBN 9780199234073
    .
  21. ISBN 9781481616232
    .
  22. PMID 19770534
    .
  23. ISBN 9781464905292
    .
  24. PMID 35203473
    .

External links

Scholia has a topic profile for Tuberculous meningitis.
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