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. Gram stain showed scanty acidfast bacilli, and he was started on antituberculosis anti. We sought to evaluate treatment outcomes for adult patients with this disease. This consequence was noted by many early researchers soon after chemotherapy was introduced.
Tuberculous meningitis in children continues to be associated with a significant risk of death even with treatment 19%, and a significant proportion of the surviving children have ongoing neurological problems. Tuberculous meningitis tbm is the most common form of central nervous. May 30, 2018 meningitis occurs when the membranes that cover the brain and spinal cord become inflamed. Tbm is typically a subacute disease with symptoms that. Antimicrobial therapy is given to treat tuberculosis infection which includes drugs like rifampicin rif, isoniazid. Tuberculous meningitis an overview sciencedirect topics. The peak incidence of tbm occurs in younger children who are less than five years of age, and most children present with latestage disease. The world health organization recommends a 12month treatment course, although data on which to base this duration is lacking. Dexamethasone for the treatment of tuberculous meningitis in. It develops as an early or late complication of primary infection. British infection society guidelines for the diagnosis and treatment of. Tuberculous meningitis is the most common presentation of intracranial tuberculosis, and usually refers to infection of the leptomeninges. 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. This report presents the results of the treatment of two series of infants and children with tuberculous meningitis.
Treatment with antibiotics and other drugs is usually effective against the infection. The authors method of chemotherapy is quite different from that in general use in this country. Predictors of stroke in patients of tuberculous meningitis. We pooled appropriate data to estimate treatment outcomes at the end of. Treatment outcomes of childhood tuberculous meningitis. Dec 31, 2018 the tuberculous meningitis treatment approach needs to consider treating the infection, related symptoms and associated complications.
This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Treatment of tuberculous meningitis and its complications in adults. Treatment of tuberculous meningitis with streptomycin. Pdf tuberculous meningitis tbm is the most common form of central nervous system tuberculosis tb and has very high morbidity and. The most lethal and disabling form of tuberculosis is tuberculous meningitis tbm, for which more than 100,000 new cases are estimated to occur per year. The most common symptoms are fever, headache, and neck stiffness. The ovid medline, embase, cochrane library and web of science databases were searched to identify all relevant studies. Risk factors tb and tb meningitis can develop in children and adults of all ages. Senior lectturer in child health, university of sheffield the purpose of this paper is to present the results of treatment of tuberculous meningitis in children who. The pathogenesis of tbm is incompletely understood and further understanding is required in order to develop effective vaccines, optimal antibiotic and host directed therapies. Uncommonly tuberculosis can be limited to the pachymeninges dura mater, it is called tuberculous pachymeningitis and is discussed separately. To prospectively evaluate the predictive factors for stroke in patients with tuberculous meningitis and to assess the impact of stroke on the overall prognosis and outcome. Mycobacterium tuberculosis bacilli enter the host by droplet inhalation. Use of corticosteroids in tuberculous meningitis the lancet.
Tuberculous meningitis, the most devastating complication of tuberculosis, is a leading cause of death among children with tuberculosis. Characteristic cerebrospinal fluid csf findings of tbm include a lymphocyticpredominant pleiocytosis, elevated protein, and low glucose. We evaluated and followed 100 patients of tuberculous meningitis for 6 months. Hydrocephalus, focal infarcts tuberculomas ct scan may be normal during the early stages of the tbm. All of these patients received streptomycin plus sodium paraaminosalicylic acid sodium pas plus isoniazid. Fitzpatrick in 19541 reported the outcome of tuberculous meningitis among. We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. Most cases of aseptic meningitis are viral and require supportive care.
An effective treatment regimen recommended by the world health organization who consists of isoniazid, rifampicin, and pyrazinamide, usually with a fourth drug such as ethambutol or streptomycin, as firstline antituberculosis drugs in patients with tuberculous meningitis 9, 10. Data sources include ibm watson micromedex updated 4 may 2020, cerner multum updated 4 may 2020, wolters kluwer updated. Mar 18, 2020 tuberculous meningitis tbm in children may mimic bacterial meningitis in the early stages. 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. It is most common in young children and individuals infected with hiv, but can affect all age groups. The first, consisting of 19 patients, was treated from may, 1947, to february, 1952, with use of a regimen of intramuscular and intrathecal streptomycin, plus oral paraaminosalicylic acid andor thiazolsulfone promizole. This is normally caused by infection but can also have noninfectious causes. Stroke is a devastating complication of tuberculous meningitis and is an important determinant of its outcome. Tuberculous radiculomyelitis or tbrm is a rare form of complication of tuberculous meningitis that has only been reported recently. Meningitis is an acute inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges.
Tuberculous meningitis is the most devastating presentation of disease with mycobacterium tuberculosis. Just over a third of all cases survives with no problems. Other symptoms include confusion or altered consciousness, vomiting, and an inability to tolerate light or loud noises. Wed like to understand how you use our websites in order to improve them. List of tuberculous meningitis medications 7 compared. Multidrugresistant tuberculous meningitis in kwazulunatal, south africa. The authors are reporting 16 consecutive cases of tuberculous meningitis started on treatment between june, 1952, and march, 1953. 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. Advances in the diagnosis and treatment of tuberculous meningitis. Clinical outcomes of patients with drugresistant tuberculous meningitis treated with an intensified antituberculosis regimen. In 1948, the modern era of tuberculosis treatment saw the first evidence of therapeutic response to streptomycin in pulmonary tb ptb 2.
Thank you for your interest in spreading the word about the bmj. Despite treatment, childhood tuberculous meningitis has very poor outcomes. It can develop at the various gaps after tbm, even in patients who have been treated with sterilization of csf. Tbm presents with nonspecific symptoms over days or weeks, followed by worsening headaches, fever and vomiting. Lumbar puncture showed an opening pressure of 28 cmh2o, white cell count 30. Dec 07, 2017 tuberculous meningitis tbm is difficult to diagnose, and a high index of suspicion is needed to make an early diagnosis. We have presented guidance on tuberculous meningitis tbm, intracerebral tuberculoma without meningitis. In persons who develop tbm, bacilli seed to the meninges or brain parenchyma, resulting in the formation of small subpial or. In patients who are coinfected with hiv1, tbm has a mortality approaching 50%. Diagnosis is based on clinical features, cerebrospinal fluid changes, and imaging characteristics. The author has recorded his experience with the use of streptomycin and isoniazid in the treatment of 298 cases of tuberculous meningitis. Treatment for tbm should be initiated as soon as clinical suspicion is supported by initial csf studies.
A 22yearold nepali man presented with intermittent confusion, fever, unsteadiness and a 10 kg weight loss over 1 month. Tuberculous meningitis is an important manifestation and is associated with high morbidity and mortality. Localized infection escalates within the lungs, with dissemination to the regional lymph nodes. Implementation of consensus definitions, standardised reporting of data, and highquality clinical. The bacteria spread to the brain and spine from another place in the body, usually the lung. Tuberculosis of the central nervous system postgraduate. Meningitis occurs when the membranes that cover the brain and spinal cord become inflamed. Tuberculous meningitis is an infection of the tissues covering the brain and spinal cord meninges.
Being a subacute illness, early symptoms may be missed leading to clinical deterioration and late presentation. Newer tests like nuclei acid amplification tests naats. The first page of the pdf of this article appears above. Effect of antituberculosis drug resistance on response to treatment and outcome in adults with tuberculous meningitis. Without antituberculosis chemotherapy, cranial nerve palsies. Tuberculous meningitis tbm is the most lethal and disabling form of tuberculosis. Meningeal tuberculosis is also known as tubercular meningitis or tb meningitis. Tuberculous meningitis tbm is caused by mycobacterium tuberculosis and kills or disables around a half of sufferers. Those surviving tuberculous meningitis frequently have serious neurological disabilities. Tbm is typically a subacute disease with symptoms that may persist for weeks before diagnosis. Tuberculous meningitis tbm can occur as the sole manifestation of tb or. Treatment of tuberculous meningitis with streptomycin samuel cohen, m. Tuberculous meningitis is the most devastating presentation of disease with.
Fitzpatrick in 19541 reported the outcome of tuberculous meningitis. 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. The diagnostic utility of bactalert and nested pcr in the diagnosis of tuberculous meningitis. Inquire about the patients medical and social history, including recent contact with patients with tuberculosis tb. Tuberculous meningitis can cause significant permanent disability and high mortality, despite prompt administration of therapy. Although the occurrence of tuberculous meningitis tbm in children is relatively rare, but it is associated with higher rates of mortality and severe morbidity. Stroke is a common complication of tuberculous meningitis. Improving early diagnosis of tuberculous meningitis in children. Tuberculous meningitis radiology reference article.
Poor prognosis and difficult early diagnosis emphasise the importance of preventive therapy for child contacts of patients with tuberculosis and low threshold for empirical treatment of tuberculous meningitis suspects. Tuberculous involvement of the brain and spinal cord are common neurological disorders in developing countries and have recently shown a resurgence in developed ones. Ziehlneelsen staining lacks sensitivity and culture. Steroids help reduce the risk of death in those without hiv. Tuberculous meningitis causes, symptoms, diagnosis. Antimicrobial therapy is given to treat tuberculosis infection which includes drugs like rifampicin rif, isoniazid inh, pyrizinamide pza and streptomycin sm. Other common features include inflammations of the adjacent blood vessels, ischemic cerebral infarction occurring due to vascular occlusion and hydrocephalus.
Senior lectturer in child health, university of sheffield the purpose of this paper is to present the results of. Young children often exhibit only nonspecific symptoms, such as. 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. We are committed to sharing findings related to covid19 as quickly and safely as possible. The current global situation for tuberculous meningitis.
Five of the 16 patients also had miliary tuberculosis. The variable natural history and accompanying clinical features of tbm hinders the diagnosis. Steroids can be used in the first six weeks of treatment, a few people may require immunomodulatory agents such as thalidomide. 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. Introduction the advent of streptomycin therapy has prolonged life in many cases of tuberculous meningitis, and on occasions, apparent cures have been noted.
Without treatment, tuberculous meningitis leads to death. The bacteria spread to the brain and spine from another place in. Tuberculous meningitis is the most severe form of tb, difficult to diagnose and treat, and with a grim prognosis. Treatment of tuberculous meningitis jama pediatrics. Mortality is frequently associated with a delay in diagnosis and treatment.
Of these, 278 were cured and 20 died, for a mortality rate of 6. Delays in seeking medical care, diagnosis, and initiation of treatment are. Dec 07, 2017 tuberculous meningitis tbm develops in 2 steps. This is normally caused by infection but can also have non. Tuberculous meningitis tbm is the most common form of central nervous system tuberculosis tb and has very high morbidity and mortality. Early treatment is critical to reduce tuberculous meningitis tbm related morbidity and mortality. Meningitis, tuberculous nord national organization for.
Treatment outcomes of tuberculous meningitis in adults. Apr 24, 2012 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 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. Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults. Tuberculous meningitis is caused by mycobacterium tuberculosis. Aseptic meningitis is the most common form of meningitis with an annual incidence of 7. 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. Dexamethasone for the treatment of tuberculous meningitis. The tuberculous meningitis treatment approach needs to consider treating the infection, related symptoms and associated complications. Liquoral findings strongly suggested a diagnosis of tuberculous meningitis, and culture results were positive for mycobacterium tuberculosis. Treatment regimens for tbm are based on evidence for pulmonary tuberculosis treatment, with little consideration to csf penetration or mode of drug action required.
Tuberculous meningitis tbm in children may mimic bacterial meningitis in the early stages. We strongly recommend that you talk with a trusted healthcare. Patients were classified by clinical criterions at admission and at the start of treatment. 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.
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