Neurosurgical management of tuberculous meningitis. Treatment of tuberculous meningitis and its complications in adults. In 2017, approximately 10 million people developed tb worldwide, of whom more than 100,000 new cases of tbm are estimated to occur per year. Central nervous system cns tuberculosis tb includes three clinical categories. Liquoral findings strongly suggested a diagnosis of tuberculous meningitis, and culture results were positive for mycobacterium tuberculosis. Although there has been a reduction in the number of patients. Treatment of tuberculous hydrocephalus depends on the level of the. This consequence was noted by many early researchers soon after chemotherapy was introduced. 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. Tuberculous meningitis g thwaites, t t h chau, n t h mai, f drobniewski, k mcadam, j farrar uncertainty and doubt dominate all aspects of tuberculous meningitis tbm.
Characteristic cerebrospinal fluid csf findings of tbm include a lymphocyticpredominant pleiocytosis, elevated protein, and low glucose. Tuberculous meningitis tbm is the most common form of central nervous. Practice guidelines for the management of bacterial. Management of hydrocephalus in patients with tuberculous.
The nonspecific clinical presentation of tuberculous meningitis has led researchers to develop newer biochemical and molecular methods of making the diagnosis. Whitley7 1drexel university college of medicine, philadelphia, pennsylvania. In 2017, approximatively 10 million people developed tuberculosis tb worldwide, of whom an estimated 1. Approach to the diagnosis and management of tuberculous. The diagnosis and medical management of tuberculous. Although there has been a reduction in the number of patients with tbm, it is estimated that in india the mortality due to tbm is approximately 1. Pdf the diagnosis and medical management of tuberculous. Meningitis occurs when the membranes that cover the brain and spinal cord become inflamed. The diagnosis of tbm in older children and adults is frequently obscured by days to weeks of nonspecific. Meningitis is an acute inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges.
However, this small possible harm is unlikely to be quantitatively. Study of tbm pathogenesis is hampered by a lack of experimental models that recapitulate all the features of the human disease. Tuberculous meningitis tbm is still a very common problem in children and adults in india. Tuberculous meningitis tbm is the most severe and dreaded manifestation of tuberculosis tb 1, 2. Fitzpatrick in 19541 reported the outcome of tuberculous meningitis.
Bcg vaccine can offer protection against some forms of tuberculosis and help in tb meningitis. Introduction the postmortem observations of green, published in the lancet in 1836, were the first to describe the distinct pathological features of tuberculous meningitis and set it apart from the other recognised causes of acute hydrocephalus green 1836. Practice guidelines for the management of bacterial meningitis. Practice guidelines for bacterial meningitis cid 2004. 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. Tbm is typically a subacute disease with symptoms that may persist for weeks before diagnosis. Surgical options for hydrocephalus include ventriculoperitoneal shunting and endoscopic third. Tuberculous meningitis tbm can occur as the sole manifestation of tb or concurrent with pulmonary or other extrapulmonary sites of infection. Tuberculous meningitis tbm can occur as the sole manifestation of tb or concurrent. Hydrocephalus is one of the most common complications of tbm. Meningitis hydrocephalus tuberculous meningitis viral meningitis tuberculous infection these keywords were added by machine and not by the authors.
Ct imaging of the brain is useful for the detection and monitoring of hydrocephalus. The variable natural history and accompanying clinical features of tbm hinders the diagnosis. Tuberculousmeningitisautopsy, showing associated brain oedema and congestion diagnosis of tb meningitis is made by analysing cerebrospinal fluid collected by lumbar puncture. Diagnosis of tuberculous meningitis international journal of. The diagnosis and management of tuberculous meningitis. The diagnosis and management of guy e thwaites oxfordwellcome trust clinical research unit, 190 ben ham tu, ho chi minh city, vietnam. The mri shows the presence, in and over the sellar seat, with parasellar left extension, of tissue with irregular margins, marked inhomogeneous enhancement, and compression of optic chiasm and of the.
Hydrocephalus is a common complication of tuberculous meningitis. This is normally caused by infection but can also have non. The supportive management of tbm complications, which include hyponatraemia. Dasturs article published in 1970 manish modi 1, manoj kumar goyal 1, anumiti jain 1, suhalika singhal sawhney 1, kusum sharma 2, sameer vyas 3, chirag kamal ahuja 3 1 department of neurology, postgraduate institute of medical education and research, chandigarh, india 2 department of medical microbiology. Those surviving tuberculous meningitis frequently have serious neurological disabilities.
Guidelines for pcr conditions were obtained from pub. Corticosteroids for managing people with tuberculous. Bacterial meningitis is very serious because its onset is rapid and the infection is associated with a significant risk of death. In patients who are coinfected with hiv 1, tbm has a mortality approaching 50%. All contributors completed a who declaration of interest form. Current who guidelines for tbm are based on those developed to treat ptb and suggest treatment with 2 months of rifampicin rmp, isoniazid. Treatment for 12 months is probably a con servative. 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. No guidelines exist as to the components and duration of treatment in the case of multidrug resistant tbm. Ziehlneelsen staining lacks sensitivity and culture.
Pdf tuberculous meningitis tbm is the most common form of central nervous system tuberculosis tb and has very high morbidity and. Tuberculous meningitis tbm is the most common form of central nervous system tuberculosis tb and has very high morbidity and mortality. Guidelines for treatment of drugsusceptible tuberculosis. Tuberculous meningitis tbm is the most severe form of tb. The diagnosis of viral meningitis requires negative csf culture for routine.
Tuberculous meningitis tbm is the most frequent form of central nervous system cns tuberculosis. When collecting csf for suspected tb meningitis, a minimum of 1 ml of fluid should be taken preferably 5 to 10ml. Peritoneal ventriculo shunt in the management of tuberculous meningitis. Tuberculous meningitis causes, symptoms, diagnosis. The first page of the pdf of this article appears above. Use of corticosteroids in tuberculous meningitis the lancet. Improving early diagnosis of tuberculous meningitis in children.
Other symptoms include confusion or altered consciousness, vomiting, and an inability to tolerate light or loud noises. Tuberculous meningitis or tb meningitis can be prevented by controlling tuberculosis infection. The diagnosis of such lesions, which include tuberculoma and tuberculous abscesses, is often presumptive and based on radiological features, supportive evidence of tb elsewhere and response to tb treatment. Diagnosis, initial management, and prevention of meningitis.
Tuberculous meningitis, the most devastating complication of tuberculosis, is a leading cause of death among children with tuberculosis. It can be treated with appropriate antibiotics that also prevents spread. For children living in areas where this infection is more common, bcg vaccine is an important vaccine in the recommended immunization schedule. The patient had no intraoperative complications and was extubated awake. Clinicians need a low threshold for suspecting meningitis, to undertake appropriate investigations and provide treatment in a timely manner, to minimise the risk of poor outcome in bacterial disease, while limiting unnecessary treatment in. Young children often exhibit only nonspecific symptoms, such as. Tuberculous intracranial mass lesions are common in settings with high tuberculosis tb incidence and hiv prevalence. The management of tuberculous meningitis find, read and cite all the research you need on researchgate. Corticosteroids reduce mortality from tuberculous meningitis, at least in the short term corticosteroids may have no effect on the number of people who survive tuberculous meningitis with disabling neurological deficit, but this outcome is less common than death, and the ci for the relative effect includes possible harm. Other common features include inflammations of the adjacent blood vessels, ischemic cerebral infarction occurring due to vascular occlusion and hydrocephalus.
Tuberculous meningitis definition tuberculous meningitis tbm is a chronic infection of the meninges caused by mycobacterium tuberculosis. In patients who are coinfected with hiv1, tbm has a mortality approaching 50%. Meningitis is an infection of the meninges, the membrane covering the brain. All three categories are encountered frequently in regions of the world where the incidence of tb is high and the prevalence of postprimary dissemination is common among. Management of hydrocephalus in patients with tuberculous meningitis vedantam rajshekhar department of neurological sciences, christian medical college, vellore, india introduction tuberculous meningitis tbm is still a very common problem in children and adults in india. Epidemiology india has one fifth of the worlds tb burden. Rajagopalan s 2015 anesthetic management of a parturient with active tuberculous meningitis lob anesth perioper med, 2015 doi. 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. Pdf treatment of tuberculous meningitis and its complications in. Management, prognosis, and prevention in children view in chinese reliably differentiate viral from bacterial meningitis. Meningitis caused by mycobacterium tuberculosis remains an important cause of morbidity and mortality worldwide, and presents specific challenges in terms of diagnosis and management.
Pdf on aug 1, 1992, m humphries and others published editorial. Tuberculous meningitis tbm is the most lethal and disabling form of tuberculosis. Indian perspective management of hydrocephalus in patients. Tuberculous meningitis tbm causes death and disability, with especially high rates of poor outcomes in children and individuals with an hiv1 coinfection. Medical therapy is recommended for the initial management of hydrocephalus. Guidelines for the treatment of tbm in adults and children have been. Tuberculous and fungal meningitis are less common in the united. British infection society guidelines for the diagnosis and treatment of. The challenge for the physician then lay in distinguishing the disease before death, and delivering the grave prognosis. Delay in diagnosis and treatment hiv, immunocompromised state. Tuberculous meningitis tbm, the most devastating manifestation of. Tuberculous meningitis tbm is a global health problem.
This process is experimental and the keywords may be updated as the learning algorithm improves. No guidelines exist as to the components and duration of. Tbm is typically a subacute disease with symptoms that. Tuberculous meningitis tbm is a frequent cause of meningitis in south africa sa and has a dismal prognosis. The role of cerebrospinal fluid shunting in tuberculous meningitis. The diagnosis and medical management of tuberculous meningitis in adults article pdf available december 2014 with 65 reads how we measure reads.
375 643 689 21 1328 394 423 516 186 48 1427 1149 345 646 74 37 481 529 1282 423 703 221 1273 780 306 848 790 188 639 860 105 170 688 445 977 1072