Tbm is typically a subacute disease with symptoms that. Professional guidelines therefore recommend the commencement of dexamethasone or a similar corticosteroid just before the first dose of. A negative cerebrospinal fluid csf xpert test excludes tbm. Tuberculous meningitis is a major cause of mortality and. Tuberculous meningitis is the most severe form of tb, difficult to diagnose and treat, and with a grim prognosis. Majority of patients in this series were found to have stageii disease at the time of admission followed by pakistan, journal of the college of physicians and surgeons pakistan 20, vol. Although tuberculous meningitis tbm is the least commonly observed form of extrapulmonary tb 515%, it is the most severe form in terms of mortality and morbidity. Tuberculous meningitis presents as either a subacute or a chronic meningitis, characterized by fever, headache, night sweats, and malaise, or a fulminant meningoencephalitis with coma, raised intracranial pressure, seizure activity, and stroke. Being a subacute illness, early symptoms may be missed leading to clinical deterioration and late presentation. Which one of the following statements is true regarding diagnosis of tbm. The bacteria spread to the brain and spine from another place in.
Patients classified as definite, probable, or possible tuberculous meningitis according to standardized definition criteria were included and assessed in the study. The hiv pandemic which predominates in low resource settings has escalated the burden of tbm most especially as hiv disease progression increases the risk of extrapulmonary tuberculosis. The objective of these practice guidelines is to provide clinicians with recommendations for the diagnosis and treatment of bacterial meningitis. Pathogenesis tuberculous meningitis is always a secondary lesion with primary usually in the lungs meningitis results from formation of a metastatic caseous lesion in the cerebral. Evolution of bacterial meningitis diagnosis in sao paulo statebrazil. Trend of bacterial meningitis in bahrain from 1990 to 20 and effect. Brain tb is the consequence of hematogenous bacilli dissemination after pulmonary infection and limited knowledge exist about the host and bacterial factors that participate in its development, so proper animal models. We focused on the significance of early diagnosis and prompt treatment.
Localized infection escalates within the lungs, with dissemination to the regional lymph nodes. Poor nutrition, poverty, household crowding, drug resistant tuberculosis tb strains, aids. Meningitis tuberculosa tuberculosis meningitis free 30. However, most published studies have been conducted in developed countries where the epidemiology and aetiology differ significantly from less developed areas. The lung is initially infected by the aereal route 1. Rupture into the subarachnoideal space or into the ventricular system produce meningitis, the most common form of cerebral tb figure 1. Steroids can be used in the first six weeks of treatment, a few people may require immunomodulatory agents such as thalidomide. The vaccines work by stimulating the immune system to create protective antibodies against the bacteria. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. Pathogenesis and immune response in tuberculous meningitis. Newer tests like nuclei acid amplification tests naats. Dec 07, 2017 tuberculous meningitis tbm develops in 2 steps. The peak incidence was below 3 years, 211 per cent.
Therefore, the objective of this cross sectional study was to describe the presentation and inhospital. Scrub typhus meningitis in south india a retrospective study. Epidemiology india has one fifth of the worlds tb burden. Tuberculous meningitis is caused by mycobacterium tuberculosis. Tuberculosis remains a global health problem, with an estimated 10.
Jun 16, 2016 we screened all inpatients with suspected meningitis or encephalitis from february 2012 till march 20. Dexamethasone for the treatment of tuberculous meningitis in. Delay in diagnosis and treatment hiv, immunocompromised state. It is commonest in young children and those infected with hiv, but can affect all agegroups. We compare two established scoring systems, thwaites and the lancet consensus scoring system for the diagnosis of tb and compare the clinical outcome in a tertiary care setting. Surveillance of bacterial meningitis, ethiopia, 201220 ncbi. Tuberculous meningitis is an infection of the tissues covering the brain and spinal cord meninges. The most lethal and disabling form of tuberculosis is. Tuberculous meningitis tbm in children may mimic bacterial meningitis in the early stages. Us department of health and human services, atlanta, ga 2014. Tbm is typically a subacute disease with symptoms that may persist for weeks before diagnosis. Meningitis tuberculosa tuberculosis meningitis free. Bacterial agents causing meningitis during 202014 in turkey. Tuberculous meningitis tbm is a major clinical and public health problem, both for diagnosis and management.
Using multiple logistic regression analysis the odds ratio obtained for the presence of bcg scar was 0. We compare two established scoring systems, thwaites and the lancet consensus scoring system for the diagnosis of tb and compare. Feb 27, 2019 meningitis outbreak was first recorded in geneva in 1805. Tuberculous meningitis is an important manifestation and is associated with high morbidity and mortality. Tuberculous meningitis causes, symptoms, diagnosis. Additionally, there may be regional differences due to variation in the socioeconomic levels, public health services and. Sinha mk, garg rk, anuradha hk, agarwal a, singh mk, verma r, et al. Epidemiology of different types of meningitis cases in gaza. December 20, 2016 tuberculous meningitis in patients living with hiv. Surveillance of bacterial meningitis, ethiopia, 201220. No serogroup c was detected among meningococcal cases. Tuberculous meningitis is the most severe manifestation of extrapulmonary tuberculosis with a high mortality rate and a high rate of sequelae among survivors. Tuberculous meningitis an overview sciencedirect topics. Characteristic cerebrospinal fluid csf findings of tbm include a lymphocyticpredominant pleiocytosis, elevated protein, and low glucose.
The aim of this study is to assess the current epidemiology, clinical features, diagnostic procedures, treatment and outcome in patients with tuberculous meningitis in denmark, a country with a low tuberculosis incidence. It is inflammation of the leptomenings piaarachnoid by mycobacterium tuberculosis 3. Tuberculous meningitis tbm is the most severe and dreaded manifestation of tuberculosis tb 1, 2. The numbers of deaths due to tuberculous meningitis worldwide. Tuberculous meningitis tbm is the most common form of central nervous system tuberculosis tb and has very high morbidity and mortality. Elfane mouna 1, sodqi mustapha 1, dollo ibrahim 1, badi hanane 1, chakib abdelfettah 1, zine karima 2, marih latifa 1, and marhoumelfilali kamal 1. Tuberculous meningitis tbm is a serious meningitic infection commonly found to occur in the developing countries endemic to tuberculosis.
It is the most severe form of tb as it causes death or severe neurological defects in more than half of those affected, despite the advancements in available antituberculosis treatment. Research clinicians used a standardised data sheet to collect demographic data, epidemiological information, clinical history, vital signs, physical observations, biochemical and microbiological data, imaging reports, treatment, outcome, and. Tuberculous meningitis radiology reference article. Elispot testing is not useful for the diagnosis of acute tb meningitis and is often false negative, but may paradoxically become positive after treatment has started, which helps to confirm the diagnosis. Treatment with antibiotics and other drugs is usually effective against the infection. Who practical guidelines, control of epidemic meningococcal disease.
Tuberculous meningitis tbm is a preventable and curable common health problem among african adults. A spiderweb clot in the collected csf is characteristic of tb meningitis, but is a rare finding. Sep 20, 2017 tuberculous meningitis is the most devastating manifestation of infection with mycobacterium tuberculosis and represents a medical emergency. Diseases of infancy and childhood 1914 14771749042. Other common features include inflammations of the adjacent blood vessels, ischemic cerebral infarction occurring due to vascular occlusion and hydrocephalus. Tuberculous meningitis at cleveland metropolitan general hospital 1959 to 1963. We performed a retrospective study of case records of adult patients. Meningitis is an acute inflammation of the protective membranes covering the brain and spinal. Media in category tuberculous meningitis the following 2 files are in this category, out of 2 total. Tuberculous meningitis tbm the most fatal presentation of tuberculosis tb especially in hivinfected patients is a real diagnostic and therapeutic challenge worldwide. In conclusion, cerebral tb is the most severe type of extrapulmonary tb and its more frequent type is tuberculous meningitis. The period of follow up varied from 6 months to over 3 years. Tuberculous meningitis definition tuberculous meningitis tbm is a chronic infection of the meninges caused by mycobacterium tuberculosis.
Tuberculous meningitis tbm is the most dreaded manifestation of tuberculosis, and is a common infection of the central nervous system cns especially in developing countries like the philippines where tuberculosis is highly endemic. Pathogenesis dissemination of bacilli to the meninges and brain occurs as a complication of the primary infection, or as a complication of an existing. Bacterial meningitis bm is a severe disease and still represents a serious. Tuberculous meningitis tbm is a form of meningitis characterized by inflammation of the membranes meninges around the brain or spinal cord and caused by a specific bacterium known as mycobacterium tuberculosis.
These guidelines provide comprehensive information on epidemiology and standard techniques for diagnosis, treatment, prevention and control of meningococcal. Tuberculous meningitis tbm is associated with significant complications of central nervous system. Gaspard vieusseux 17461814 and andre matthey 17781842 in geneva, and elisa north 17711843 in massachusetts, described epidemic. Pathogenesis dissemination of bacilli to the meninges and brain occurs as a complication of the primary infection, or as a complication of an existing tb lesion tuberculoma, miliary tb or reactivation of. Successful vaccination policies for protection from bacterial meningitis are. The incidence follows that of pulmonary tuberculosis, and is associated with high mortality and morbidity.
Cureus a case report on complicated tuberculous meningitis. The most feared consequence of infection with mycobacterium tuberculosis in infants and young children is tuberculous meningitis. It develops as an early or late complication of primary infection. Tuberculous meningitis tbm is caused by mycobacterium tuberculosis and kills or disables around a half of sufferers. Tuberculosis tb is a disease which has been affecting humanity since archaic ages. We describe a case of tbm in a 19yearold asian female. Central nervous system cns infections are a significant contributor to morbidity and mortality globally.
Neuroimaging features of tuberculous meningitis include hydrocephalus, meningeal enhancement, infarction, enhancing lesion, tuberculoma, abcess, cerebral oedema and calcification. It is accompanied by nonspecific and heterogeneous clinical symptoms. In a fiveyearperiod, 288 cases of tuberculous meningitis were seen in in the r. Apr 17, 2014 pathogenesis tuberculous meningitis is always a secondary lesion with primary usually in the lungs meningitis results from formation of a metastatic caseous lesion in the cerebral cortex, meninges and choroid plexus during the process of initial occult lymphohematogenous spread of primary infection.
Diagnosis is based on clinical features, cerebrospinal fluid changes, and imaging. Pdf tuberculosis remains a global health problem, with an estimated 10. Tuberculous meningitis can cause significant permanent disability and high mortality, despite prompt administration of therapy. Tuberculous meningitis tbm is the most frequent form of central nervous system cns tuberculosis. Tb meningitis tuberculous meningitis can display symptoms such as aches and pains, loss of appetite and tiredness, with a persistent headache, there are around 150 200 cases of tb meningitis reported each year in the uk. If you have problems viewing pdf files, download the latest version of adobe reader for language access assistance, contact the ncats public information officer genetic and rare diseases information center gard po box 8126, gaithersburg, md 208988126 tollfree.
Tbm presents with nonspecific symptoms over days or weeks, followed by worsening headaches, fever, and vomiting. Overview of vaccines there are several safe and very effective vaccines to protect against major causes of bacterial meningitis. Patients with bacterial meningitis are usually treated by primary care and emergency medicine physicians at the time of initial presentation, often in consultation with infectious diseases specialists, neurologists, and neurosurgeons. Tuberculous meningitis is the severest form of infection with mycobacterium tuberculosis, causing death or severe neurologic deficits in more than half of those affected in spite of.
Tuberculous meningitis is the most common presentation of intracranial tuberculosis, and usually refers to infection of the leptomeninges. Mycobacterium tuberculosis bacilli enter the host by droplet inhalation. In the 1930s, researchers established that infants and young children are particularly susceptible to tuberculous meningitis, and that it is the major cause of tuberculosisrelated childhood death 1, 2. In persons who develop tbm, bacilli seed to the meninges or brain parenchyma, resulting in the formation of small subpial or. Practice guidelines for the management of bacterial meningitis. Based on the clinical features alone, the diagnosis of tbm can neither be made nor excluded with certainty. Tuberculous meningitis tbm is a condition ideally characterized as meningoencephalitis, as it not only affects the meninges but also the brain parenchyma as well as the vasculature. Figure 1 pathogenesis and immune response of cerebral tuberculosis. Vol 367 april 8, 2006 number of vaccinations needed to prevent one case of meningitis is therefore 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. In cameroon where hiv and tb are amongst the leading public health problems, the magnitude of tbm has not been defined. Tuberculous meningitis tbm is a chronic infection of the meninges caused by mycobacterium tuberculosis. We aimed to describe and to assess prognosis factors in tuberculous meningitis in adult patients. Steroids help reduce the risk of death in those without hiv.
The bacteria spread to the brain and spine from another place in the body, usually the lung. Tuberculous meningitis tbm is the most severe form of infection caused by mycobacterium tuberculosis, causing death or disability in more than half of those affected. A comparison of scoring systems for diagnosis roshan kurien, thambu david sudarsanam, samantha s, and kurien thomas oman medical journal 20 vol. Clinical features and outcome in adult cases of tuberculous. Cranial nerve palsy as a factor to differentiate tuberculous meningitis from acute bacterial meningitis. From an incurable scourge to a curable disease journey over a millennium. In 20 meningitis resulted in 303,000 deaths down from 464,000 deaths in 1990. Ct scan is an adequate neuroimaging tool to unmask abnormal findings in. Jun 11, 20 tuberculous meningitis tbm the most fatal presentation of tuberculosis tb especially in hivinfected patients is a real diagnostic and therapeutic challenge worldwide.
Trend of bacterial meningitis in bahrain from 1990 to 20 and effect of introduction of new vaccines. This chapter presents a discussion on tuberculous meningitis. Of 215 cases discharged as relieved, only 117 cases were followed up. Tuberculous meningitis indiana university school of medicine.
She had a progressive motor weakness with no sensory findings. The treatment of tuberculous meningitis has always been more or less haphazard, largely symptomatic, and entered upon by the clinician with very little enthusiasm and with even less hope of success because of the very general opinion of the uniform fatality of the disease. Nov 01, 2004 in one study of 78 patients with acute meningitis in which csf lactate concentrations of 4. The diagnosis and medical management of tuberculous. The two commonest neuroimaging features are hydrocephalus and meningeal enhancement.
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