New Delhi: Tuberculosis (TB) is a common infection prevalent in many countries especially in developing countries. It is a disease associated with poverty, overcrowding, drug abuse, smoking, alcoholism, homelessness, and immune deficiency states. Tuberculous meningitis is caused by Mycobacterium tuberculosis. This is the bacterium that causes tuberculosis (TB). This bacteria can spread from the spine to the brain and other body parts, even the lungs. It has become more important with the advent of HIV. Recent data from the World Health Organisation (WHO) has shown the maximum number of cases of multi-drug resistant TB with nearly half a million cases being diagnosed every year.
What are the symptoms of TB meningitis?
The symptoms often start slowly, and may include:
- Fever with/ without chills
- Mental status changes
- Nausea, vomiting
- Sensitivity to light (photophobia)
- Severe headache
- Stiff neck (meningismus)
Other symptoms of TB meningitis are:
- Agitation
- Bulging fontanelles (soft spots) in infants
- Decreased consciousness
- Poor feeding or irritability in children
- Head and neck bending backward, mostly in infants younger than three months
Diagnosis clinical:
- Fast heart rate
- Fever
- Mental status changes
- Stiff neck
Diagnosis of TB meningitis
A lumbar puncture (spinal tap) for cerebrospinal fluid (CSF) is an important test in diagnosing meningitis. This test is done to collect spinal fluids for diagnosis.
- Blood culture
- Chest x-ray
- CT or MRI scan of the head
- Skin test for TB (montoux test) (MT)
- Treatment
Anti-TB medications need to be started at the earliest, at times with a steroid course to control the disease and its complications. Treatment usually lasts for at least 12 – 18 months. The strategy for control of tuberculosis lies in early detection, quick diagnosis, and treatment. Late treatment can cause complications, disabilities morbidity, and mortality. Untreated or delayed treatment- the disease can cause any of the following:
- Brain damage
- Strokes
- Hearing loss
- Hydrocephalus – which is fluid buildup inside the skull leading to brain swelling
Risk of it becoming Multidrug-resistant (MDR) TB or Extensively drug-resistant (XDR) TB which has poor outcomes
- Seizures
- Death
The diagnosis of tuberculous meningitis can be a challenge at times. cases of TBM at times cannot be confirmed based only on clinical and imaging findings as the clinical findings can be nonspecific, while laboratory techniques may not give you the answers as they have low sensitivity & results take time to come.
Recent Advances and the Future:
- Laboratory methods to improve the rapid diagnosis of TBM are available.
- Optimal drug combinations are tailor-made for MDR and XDR TB cases
- The use of biomarkers to improve the rapid diagnosis of TBM needs further investigation.
- The role of novel antituberculosis drugs, such as bedaquiline in the treatment of TBM remains to be explored further.
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