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What is Tuberculous Meningitis?

Meninges are a set of three membranes covering the brain and spinal cord. They provide protection and nutrition to these organs. The infection of these meninges by the bacteria responsible for causing tuberculosis i.e. Mycobacterium tuberculosis is known as Tuberculous meningitis. It is also known as TB meningitis.

Understanding the ailment:

Meningitis can be caused by an array of organisms including viruses, fungi, and other bacteria. However, TB meningitis is specific for the bacteria mentioned above. The bacteria find their way to the matter of the brain and initiate inflammation and irritation of the meninges. It can also affect the nerves arising from the brain and cause neurological deficits.

What are the causes of Tuberculous Meningitis?

The bacteria enter the human body via inhalation of droplets sneezed or coughed in the air contaminated by a TB patient. These bacteria then reach the lungs and cause TB. The infection can start from organs other than the lungs too. In about 1–2% of people, bacteria reach the brain and cause TB meningitis.

What are the risk factors for Tuberculous Meningitis?

  • HIV/AIDS patients
  • People living in poor hygienic conditions
  • Alcoholics
  • Incompletely treated previous TB or defaulters

Also Read: 10 Meningitis Signs You Need to Look Out For

What are the symptoms of Tuberculous Meningitis?

  • Fever
  • Headache
  • Vomiting
  • Rigidity in the neck and back
  • Double vision, intolerance to light and even blindness may occur
  • Paralysis and loss of sensations
  • Altered consciousness, seizures can occur
  • Ear infections
  • Urinary incontinence

Also Read: Fungal Meningitis: Overview, Symptoms and Treatment

How is Tuberculous Meningitis diganosed?

Physical examination:

  • Neck rigidity is assessed by flexing the neck
  • Other physical signs like Kernig’s sign and Brudzinski’s neck sign are checked

Other lab investigations:

  • CT scan and MRI to visualize the meninges and signs of inflammation
  • Cerebrospinal fluid (CSF) examination to look for bacterial presence and immune response
  • CSF culture for isolation of tuberculous bacteria
  • Blood counts and Chest X-Ray
  • ICP (Intra Cranial Pressure) is measured
  • Blood culture to look for organisms in the blood
  • Skin biopsy if any skin lesions are present

What is the treatment for Tuberculous Meningitis?

  • Anti TB chemotherapy should be started as early as possible
  • Steroids are given to decrease inflammatory response
  • Management of other parameters like sugar, BP and respiration

Also Read: Bacterial Meningitis: Overview, Symptoms and Treatment

What are the complications with Tuberculous Meningitis?

  • Complications related to blood supply and nerve functions can arise leading to neurological deficits. This can include loss of sensations, function, and paralysis of any part of the body. Cognitive impairment and epilepsies are the most common complications seen in long-term survivors
  • Meningitis can cause secondary infections in other organs
  • It can cause systemic response like shock (severe fall in BP), respiratory problems, etc.
  • Delayed complications like hydrocephalus, stroke, cranial nerve palsies, epilepsy, and hyponatremia may appear frequently depending on the severity of the disease even after the patient undergoes complete treatment
  • Hepatotoxicity (damage to the liver) can be seen due to the drugs used for treating TB (anti-tuberculosis treatment) in few patients

Also Read: Viral Meningitis: Overview, Symptoms and Treatment

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