On a macroscopic level there are the mechanisms by which the tuberculous bacilli disseminate to the cns. Tuberculous meningitis is an infection of the tissues covering the brain and spinal cord meninges. In many developing countries, tuberculous meningitis is common. 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. The dots in the air represent droplet nuclei containing tubercle bacilli. A crosssectional study was conducted between february and april 2014.
Chapter 2 transmission and pathogenesis of tuberculosis. Tuberculous and fungal meningitis are less common in the united. Pathophysiology and prognosis in vietnamese adults with. Diagnosis, initial management, and prevention of meningitis. Tuberculous meningitis is caused by mycobacterium tuberculosis. Tbm is typically a subacute disease with symptoms that. Meningeal tuberculosis is also known as tubercular meningitis or tb meningitis.
Localized infection escalates within the lungs, with dissemination to the regional lymph nodes. The variable natural history and accompanying clinical features of tbm hinders the diagnosis. Tuberculous meningitis tbm is the most common form of central nervous system tuberculosis tb and has very high morbidity and mortality. Jul 16, 2019 tuberculous meningitis should always be considered in the differential diagnosis of patients with aseptic meningitis or chronic meningitis syndromes, especially those with basilar meningitis, symptoms of more than 5 days duration, or cranial nerve palsies. The aim of this study was to study the clinical presentation, aetiology, and outcomes of meningitis among adult patients admitted to queen mamohato memorial hospital in maseru, lesotho, with a diagnosis of meningitis. Tuberculous granuloma tuberculoma tuberculous granuloma tuberculoma is the most common form of parenchymal tuberculosis, which may develop with or without concomitant tuberculous meningitis or miliary tuberculosis. Less common etiologies for aseptic meningitis include tuberculous meningitis mycobacterium tuberculosis, lyme disease borrelia spp. If tuberculous meningitis is suspected, antituberculosis therapy, with or without. Nov 07, 2017 this feature is not available right now. Being a subacute illness, early symptoms may be missed leading to clinical deterioration and late presentation. Dec 07, 2017 tuberculous meningitis tbm develops in 2 steps. Mar 18, 2020 tuberculous meningitis tbm in children may mimic bacterial meningitis in the early stages. Pathogenesis and immune response in tuberculous meningitis.
Risk factors tb and tb meningitis can develop in children and adults of all ages. Dec 31, 2018 tuberculous meningitis or tb meningitis can be prevented by controlling tuberculosis infection. The bacteria spread to the brain and spine from another place in the body, usually the lung. Tbm commonly causes subacute or chronic meningitis. Cerebral tb is often fatal 30% and many of survival patients have. Acute bacterial meningitis merck manuals professional edition. However, the pathogenesis of this disease is unclear. Tuberculomas arise from tuberculous foci, which did not rupture into the subarachnoid space. We present a case of a 23yearold woman with a 2week history nocturnal fever, vertigo, headache and projectile vomiting. Tbm is typically a subacute disease with symptoms that may persist for weeks before diagnosis. 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.
Nov 07, 2019 extrapulmonary tuberculosis is challenging to diagnose, but knowledge of its pathophysiology and imaging features can help the radiologist identify this infectious disease in highrisk patients. Tuberculous meningitis an overview sciencedirect topics. 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. The entry of mycobacterium tuberculosis into our body causes of tube. Tuberculous meningitis causes, symptoms, diagnosis. Investigation of 200 cases of tuberculous meningitis led to the conclusion that in the origin of the process, tuberculous foci within the central nervous system or its immediate vicinity are playing the decisive role. Mycobacterium tuberculosis bacilli enter the host by droplet inhalation. May 08, 2020 tuberculous meningitis is the most severe form of tb, difficult to diagnose and treat, and with a grim prognosis. Tuberculous meningitis tbm is the most serious e xtrapulmonary manifestation of tuberculosis tb with mortality rates up to 50% observed in the context of hiv1 coinfection. Newer tests like nuclei acid amplification tests naats. In patients with suspected herpes simplex virus hsv infection, empiric antiviral therapy is started to prevent complications of hsv encephalitis. The pathogenesis of tbm is incompletely understood and further understanding is required in order to develop effective vaccines, optimal antibiotic and host directed therapies. In tuberculous meningitis, csf acidfast staining can be insensitive, sensitivity of pcr is only about 50%, and culture requires up to 8 weeks. Other articles where tuberculous meningitis is discussed.
Dec 11, 20 there are different clinicalpathological manifestations of cerebral tb. Tubercles rupture in subarachnoid area causes meningitis. Central nervous system cns tuberculosis tb includes three clinical categories. If no organism can be isolated with routine culture and sensitivity assays of cerebrospinal fluid csf, the condition is called aseptic meningitis, and the etiology is likely viral e. Positive csf interferongamma tests indicate tuberculous meningitis, but serum interferongamma tests may only indicate prior infection. The pathophysiology of tuberculous meningitis has bacilli root itself to the brain parenchyma, which causes the formation of small subpial focus. They invade the meninges either by direct contact or through the perivascular lymph spaces 71%. Deep gray nuclei are also often involved, since tuberculous angiopathy mainly affects the perforating vessels 1. Tuberculous meningitis tbm is the most frequent form of central nervous system cns tuberculosis. This is the first reported case of a chiari 1 malformation in association with tuberculous tb meningitis. Sometimes it may present with cranial nerve deficits, or it may have a more indolent course involving headache, meningismus, and altered mental status. Other common features include inflammations of the adjacent blood vessels, ischemic cerebral infarction occurring due to vascular occlusion and hydrocephalus secondary to the dynamic disturbance of csf.
She had nystagmus, scanning speech, bilateral papilloedema and ataxia. Tuberculous meningitis tbm is the most serious extrapulmonary manifestation of tuberculosis with mortality rates up to 50% observed in the context of hiv1 coinfection. 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 are required. Ziehlneelsen staining lacks sensitivity and culture. Innate immunity is crucial in pulmonary response and is essentially carried out by alveolar macrophages and dendritic cells, which recognize diverse bacterial moieties or pathogen. Delay in diagnosis and treatment hiv, immunocompromised state. Other common features include inflammations of the adjacent blood vessels, ischemic cerebral infarction occurring due to vascular occlusion and hydrocephalus. Tb is spread from person to person through the air. This is discussed alongside the role of granulomatous in.
Oct 15, 2003 tuberculous meningitis tbm is the most dangerous form of infection with mycobacterium tuberculosis. Then there is an increase in size of rich focus until rupture. Tuberculous meningitis tbm causes death and disability, with especially high rates of poor outcomes in children and individuals with an hiv1 coinfection. Tuberculous meningitis tbm is a very severe form of tuberculosis, which affects not only meninges but also adjacent parenchyma of the brain 1,2. Bcg vaccine can offer protection against some forms of tuberculosis and help in tb meningitis. Tuberculous meningitis can cause significant permanent disability and high mortality, despite prompt administration of therapy. 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. Evaluation of lactate dehydrogenase activity in cerebrospinal.
Characteristic cerebrospinal fluid csf findings of tbm include a lymphocyticpredominant pleiocytosis, elevated protein, and low glucose. Extrapulmonary tuberculosis tb represents approximately 15% of all tb infections. Cranial imaging showed a 10 mm tonsillar herniation. Tuberculosis tb is defined as a disease caused by members of the m. In persons who develop tbm, bacilli seed to the meninges or brain parenchyma, resulting in the formation of small subpial or. Distinguishing between viral and bacterial meningitis is done using blood and csf cultures, as well as lumbar puncture opening pressure which reflects icp and csf analysis. Despite modern chemotherapy, it is fatal in 25% of adults and causes neurological sequelae in 25% of survivors. In conclusion, cerebral tb is the most severe type of extrapulmonary tb and its more frequent type is tuberculous meningitis. For children living in areas where this infection is more common, bcg vaccine is an important vaccine in the recommended immunization schedule. In the tuberculous process, the spinal meninges may be involved, owing to the spread of infection from intracranial meningitis, primary spinal meningitis in isolation as a result of a tuberculous focus on the surface of the cord rupturing into the subarachnoid space, or transdural extension of infection from caries of the spine. Oct 30, 2017 in this lecture the pathophysiology and pathogenesis of tuberculosis has been discussed.