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Meningeal Tuberculosis

Meningitis Tuberculous


Presentation

  • The genotype of M. tuberculosis influenced the presenting features of pulmonary and meningeal tuberculosis.[ncbi.nlm.nih.gov]
  • We present a patient with spinal intradural tuberculosis in the absence of both vertebral and meningeal tuberculosis. Diagnosis was made based on intra-operative findings and was confirmed by histopathology.[ncbi.nlm.nih.gov]
  • A 19-year-old woman presented with headaches and behavioral changes. A sudden decrease in visual acuity with papilledema, bilateral sixth nerve palsies, and neck stiffness developed. Lumbar puncture showed elevated opening pressure (50 cm H2O).[ncbi.nlm.nih.gov]
  • TBM may have an acute presentation. Sometimes it may present with cranial nerve deficits, or it may have a more indolent course involving headache, meningismus, and altered mental status.[emedicine.com]
Fever
  • This will usually show that you have the following: Fast heart rate Fever Mental status changes Stiff neck A lumbar puncture ( spinal tap ) is an important test in diagnosing meningitis.[nlm.nih.gov]
  • At the first contact to a doctor, seven patients were diagnosed as having common cold or headache related with fever because of the lack of typical signs of meningitis.[ncbi.nlm.nih.gov]
  • During the early stage of infection patient may complain of tiredness, weakness, mild grade fever, loss of appetite.[tandurust.com]
  • Fever and headache are the cardinal features; confusion is a late feature and coma bears a poor prognosis. Meningism is absent in a fifth of patients with TB meningitis. Patients may also have focal neurological deficits.[en.wikipedia.org]
  • Important risk factors include: HIV/AIDS immunosuppression diabetes mellitus alcoholism Low grade fever with headache is a prodromal manifestation. Most common clinical manifestations are fever, headache, vomiting and neck stiffness.[radiopaedia.org]
High-Pitched Cry
  • Hydrocephalus (buildup of fluid inside the skull that leads to brain swelling) Seizures Death Call the local emergency number (such as 911) or go to an emergency room if you suspect meningitis in a young child who has the following symptoms: Feeding problems High-pitched[nlm.nih.gov]
Vomiting
  • In the beginning the symptoms are vague, but gradually the symptoms become more obvious which include severe vomiting, fever, severe headache, neck rigidity, and mental confusion. Seizures may develop in some patients.[tandurust.com]
  • Early diagnosis is difficult because patients tend to present subacutely with nonspecific symptoms such as fever, cough, vomiting, listlessness, and failure to thrive.[ncbi.nlm.nih.gov]
  • DAY TO DAY ASSESSMENT Day 1- c/o- o chronic Headache on and off from 15 days. o vomiting Medication- Tab. Calpol (paracetamol) 650 mg SOS Vitals- NORMAL Advice: Chest x-ray 10.  Day 2-  Pt.stable  Montox reactive  Vitals normal Rx- Inj.[slideshare.net]
  • Tuberculois meningitis begins insidiously with a gradual fluctuating fever, fatigue, weight loss, behavior changes, headache, and vomiting. This early phase is followed by neurologic deficits, loss of consciousness, or convulsions.[medicinenet.com]
  • […] have the following have a higher chance of developing tuberculous meningitis: HIV/AIDS Drink alcohol in excess TB of the lung Weakened immune system The symptoms often start slowly, and may include: Fever and chills Mental status changes Nausea and vomiting[nlm.nih.gov]
Nausea
  • People who have the following have a higher chance of developing tuberculous meningitis: HIV/AIDS Drink alcohol in excess TB of the lung Weakened immune system The symptoms often start slowly, and may include: Fever and chills Mental status changes Nausea[nlm.nih.gov]
  • These stages are described below: Stage I This first stage is characterized by the presence of nonspecific symptoms such as irritability, apathy, fever, malaise, headache, vomiting, nausea and anorexia without any changes in the levels of consciousness[hxbenefit.com]
  • Instead, you may experience the following symptoms: fever confusion nausea and vomiting lethargy irritability unconsciousness Your doctor will perform a physical exam and ask you about your symptoms and medical history.[healthline.com]
  • Common complaints include headaches, stiff neck, fever, weight loss, blurred vision, confusion, lethargy, nausea, vomiting and for spinal cord lesions - lower extremity weakness or bowel or bladder symptoms.[doctor.ndtv.com]
  • The patient was a 25-year-old female who was admitted to our hospital on Dec 10, 1996 because of fever, nausea, and headache.[ginmu.naramed-u.ac.jp]
Loss of Appetite
  • During the early stage of infection patient may complain of tiredness, weakness, mild grade fever, loss of appetite.[tandurust.com]
  • […] of appetite and tiredness, usually with a persistent headache These vague symptoms can last for several weeks before more specific symptoms of meningitis, such as severe headache, dislike of bright lights and neck stiffness occur The slow progression[meningitisnow.org]
  • But the common symptoms include fatigue, weight loss, loss of appetite, and fever.[dovemed.com]
Headache
  • At the first contact to a doctor, seven patients were diagnosed as having common cold or headache related with fever because of the lack of typical signs of meningitis.[ncbi.nlm.nih.gov]
  • A 19-year-old woman presented with headaches and behavioral changes. A sudden decrease in visual acuity with papilledema, bilateral sixth nerve palsies, and neck stiffness developed. Lumbar puncture showed elevated opening pressure (50 cm H2O).[ncbi.nlm.nih.gov]
  • Fever and headache are the cardinal features; confusion is a late feature and coma bears a poor prognosis. Meningism is absent in a fifth of patients with TB meningitis. Patients may also have focal neurological deficits.[en.wikipedia.org]
  • Important risk factors include: HIV/AIDS immunosuppression diabetes mellitus alcoholism Low grade fever with headache is a prodromal manifestation. Most common clinical manifestations are fever, headache, vomiting and neck stiffness.[radiopaedia.org]
  • Headache and meningeal irritation may be followed by SEIZURES, cranial neuropathies, focal neurologic deficits, somnolence, and eventually COMA.[connects.catalyst.harvard.edu]
Seizure
  • Seizures are commonly observed in children. Without treatment the disease progresses rapidly which may lead to coma and death of the patient.[tandurust.com]
  • Headache and meningeal irritation may be followed by SEIZURES, cranial neuropathies, focal neurologic deficits, somnolence, and eventually COMA.[connects.catalyst.harvard.edu]
  • Stage III This final stage is marked by an advanced state of coma or stupor, seizures, dense neurological deficits, posturing as well as abnormal movements.[hxbenefit.com]
  • Untreated, the disease can cause any of the following: Brain damage Build-up of fluid between the skull and brain ( subdural effusion ) Hearing loss Hydrocephalus (buildup of fluid inside the skull that leads to brain swelling) Seizures Death Call the[nlm.nih.gov]
  • When the diagnosis of meningitis was obtained based on the findings of the cerebrospinal fluid (CSF), focal neurological signs including psychological symptoms, cranial nerve palsies and seizure were noted besides meningeal signs or the disturbance of[ncbi.nlm.nih.gov]
Irritability
  • Nausea and vomiting Sensitivity to light ( photophobia ) Severe headache Stiff neck (meningismus) Other symptoms that can occur with this disease may include: Agitation Bulging fontanelles (soft spots) in babies Decreased consciousness Poor feeding or irritability[nlm.nih.gov]
  • Headache and meningeal irritation may be followed by SEIZURES, cranial neuropathies, focal neurologic deficits, somnolence, and eventually COMA.[connects.catalyst.harvard.edu]
  • These stages are described below: Stage I This first stage is characterized by the presence of nonspecific symptoms such as irritability, apathy, fever, malaise, headache, vomiting, nausea and anorexia without any changes in the levels of consciousness[hxbenefit.com]
  • With progression of the disease patient may present with other classical symptoms of TB meningitis such as fever, projectile vomiting, severe headache, neck rigidity, sensitivity to light, confusion and altered mental status, seizures, increased irritability[tandurust.com]
  • Instead, you may experience the following symptoms: fever confusion nausea and vomiting lethargy irritability unconsciousness Your doctor will perform a physical exam and ask you about your symptoms and medical history.[healthline.com]
Confusion
  • Fever and headache are the cardinal features; confusion is a late feature and coma bears a poor prognosis. Meningism is absent in a fifth of patients with TB meningitis. Patients may also have focal neurological deficits.[en.wikipedia.org]
  • In the beginning the symptoms are vague, but gradually the symptoms become more obvious which include severe vomiting, fever, severe headache, neck rigidity, and mental confusion. Seizures may develop in some patients.[tandurust.com]
  • Instead, you may experience the following symptoms: fever confusion nausea and vomiting lethargy irritability unconsciousness Your doctor will perform a physical exam and ask you about your symptoms and medical history.[healthline.com]
  • Tuberculous Meningitis Symptoms TBM can give rise to the following signs and symptoms: Chills Fever Coma Stroke Fatigue Nausea Malaise Myalgia Aphasia Seizures Tremors Agitation Vomiting Dizziness Blindness Headache Confusion Myoclonus Hemiplegia Monoplegia[hxbenefit.com]
  • Common complaints include headaches, stiff neck, fever, weight loss, blurred vision, confusion, lethargy, nausea, vomiting and for spinal cord lesions - lower extremity weakness or bowel or bladder symptoms.[doctor.ndtv.com]
Altered Mental Status
  • With progression of the disease patient may present with other classical symptoms of TB meningitis such as fever, projectile vomiting, severe headache, neck rigidity, sensitivity to light, confusion and altered mental status, seizures, increased irritability[tandurust.com]
  • mental status Tuberculous spondylitis Decreased consciousness Meningismus or stiff neck Focal neurological deficits Sensorineural hearing loss Bulging fontanelles in infants Changes in the mental status Tuberculous encephalopathy Tuberculous spinal meningitis[hxbenefit.com]
  • Signs of meningitis may include altered mental status, fever, seizures, etc.[doctor.ndtv.com]
  • Patients will most often present with fever, headache and altered mental status.[clinicaladvisor.com]
  • Sometimes it may present with cranial nerve deficits, or it may have a more indolent course involving headache, meningismus, and altered mental status. The prodrome is usually nonspecific, including headache, vomiting, photophobia, and fever.[emedicine.com]

Workup

  • (See Workup.) Prompt treatment is essential; death may occur as a result of missed diagnoses and delayed treatment. Antimicrobial therapy is best started with isoniazid, rifampin, pyrazinamide; addition of a fourth drug is left to local choice.[emedicine.com]
Anergy
  • Anergy to tuberculin was uncommon; only 2% of the patients reacted negatively to 1.0 mg. O.T. Forty-eight per cent of the cases occurred before the age of 2 years, and two thirds before the age of 4 years.[pediatrics.aappublications.org]
  • Anergy, or absence of PPD reactivity in persons infected with TB, can occur in immunocompromised persons, or it may even occur in persons newly infected with TB, or in persons with miliary TB. Injecting PPD intracutaneously, gross.[library.med.utah.edu]
Brain Edema
  • Brain edema and disorders of cerebrospinal fluid circulation. In: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; 2016:chap 88. Updated by: Amit M.[nlm.nih.gov]

Treatment

  • We compared in-hospital treatment outcome of patients on thrice weekly intermittent DOTS regimen with daily regimen patients. RESULTS: The inhospital mortality was same (27%) in the two treatment regimens (p 0.944).[ncbi.nlm.nih.gov]
  • Randomized controlled trials that compared corticosteroid plus antituberculous treatment with antituberculous treatment alone in people with clinically diagnosed tuberculous meningitis and included death or disability as outcome measures.[ncbi.nlm.nih.gov]
  • Cochrane reviews have summarized the evidence for adjunctive corticosteroids in the treatment of tuberculous pericarditis, meningitis and pleural effusion.[ncbi.nlm.nih.gov]
  • ELISPOT testing is not useful for the diagnosis of acute TB meningitis and is often false negative, but may paradoxically become positive after treatment has started, which helps to confirm the diagnosis.[en.wikipedia.org]
  • HIV seropositivity, steroid treatment or delay in treatment did not affect mortality. CONCLUSIONS: Identification of factors predictive of in-hospital mortality will help to prognosticate patients with meningeal TB at the time of admission.[ncbi.nlm.nih.gov]

Prognosis

  • Prognosis is related directly to the clinical stage at diagnosis. (See Prognosis.) TBM may have an acute presentation.[emedicine.com]
  • Fever and headache are the cardinal features; confusion is a late feature and coma bears a poor prognosis. Meningism is absent in a fifth of patients with TB meningitis. Patients may also have focal neurological deficits.[en.wikipedia.org]
  • […] six weeks. 2 Tuberculous Meningitis in Children and Adults: New Insights for an Ancient Foe Alyssa Mezochow,Kiran Thakur,Christopher Vinnard Current Neurology and Neuroscience Reports. 2017; 17(11) 3 Old age and hydrocephalus are associated with poor prognosis[doi.org]

Etiology

  • Similarly three other patients were initially diagnosed as having meningitis due to viral infection or unknown etiology.[ncbi.nlm.nih.gov]
  • Etiology The causative organism is Mycobacterium tuberculosis. Various risk factors have been identified. The first description of TBM is credited to Robert Whytt, on the basis of his 1768 monograph, Observations of Dropsy in the Brain.[emedicine.com]
  • (Etiology) Disseminated Tuberculosis is a contagious bacterial infection that has spread from the lungs to other parts of the body through the blood or lymph system It is caused by Mycobacterium tuberculosis, a pathogenic bacterium The infection is acquired[dovemed.com]

Epidemiology

  • (See Epidemiology.) TBM is a very critical disease in terms of fatal outcome and permanent sequelae, requiring rapid diagnosis and treatment.[emedicine.com]
  • The diagnosis is mainly clinical and should be considered in a specific epidemiological context. Culture of Mycobacterium tuberculosis from cerebrospinal fluid is required for definitive diagnosis but it cannot always be obtained.[moh-it.pure.elsevier.com]
  • For LTBI, research needs to address different epidemiological and clinical settings, to evaluate the performance of the main existing commercial assays in head-to-head comparison in both developed and developing countries, and to assess the role of adding[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • The pathophysiology of tuberculous meningitis has bacilli root itself to the brain parenchyma, which causes the formation of small subpial focus. Then there is an increase in size of Rich focus until rupture.[en.wikipedia.org]
  • (See Pathophysiology.) Currently, more than 2 billion people (ie, one third of the world’s population) are infected with tuberculosis (TB), of which approximately 10% will develop clinical disease.[emedicine.com]

Prevention

  • Treating people who have signs of a non-active (dormant) TB infection can prevent its spread. A PPD test and other TB tests can be done to tell if you have this type of infection.[nlm.nih.gov]
  • Cases were patients with microbiologically proven tuberculous meningitis; controls were patients in whom Mycobacterium tuberculosis could not be isolated but met the Centers for Diseases Control and Prevention (CDC) criteria for non-proven tuberculous[ncbi.nlm.nih.gov]
  • The best way to prevent TB meningitis is to prevent TB infections. In communities where TB is common, the Bacillus Calmette-Guérin (BCG) vaccine can help control the spread of the disease.[healthline.com]
  • The use of the corticosteroid dexamethasone improves survival in patients over 14 years of age but probably does not prevent severe disability. Reviewed on 12/21/2018[medicinenet.com]
  • Tuberculous Meningitis Prevention The BCG vaccination can help to prevent TBM in young children living n places where this disease is quite common.[hxbenefit.com]

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