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Meningitis - tuberculous

Definition

Tuberculous meningitis is an infection of the tissues covering the brain and spinal cord (meninges).

Alternative Names

Tubercular meningitis; TB meningitis

Causes

Tuberculous meningitis is caused by Mycobacterium tuberculosis. This is the bacteria that causes tuberculosis (TB). The bacteria spread to the brain and spine from another place in the body.

Tuberculous meningitis is very rare in the U.S. Most cases are people who travelled to the U.S. from other countries where TB is common.

People who have the following have a higher chance of developing tuberculous meningitis:

Symptoms

The symptoms often start slowly, and may include:

Other symptoms that can occur with this disease may include:

  • Agitation
  • Bulging fontanelles in babies
  • Decreased consciousness
  • Poor feeding or irritability in children
  • Unusual posture, with the head and neck arched backwards (opisthotonos)

Exams and Tests

The health care provider will examine you. 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. It is done to collect a sample of spinal fluid for examination. More than one sample may be needed to make the diagnosis.

Other tests that may be done include:

Treatment

You will be given several medicines to fight the tuberculosis bacteria. Sometimes, treatment is started even if your doctor thinks you have the disease, but testing has not confirmed it yet.

Treatment usually lasts for at least 12 months. Medicines called coticosteroids may also be used.

Outlook (Prognosis)

Tuberculous meningitis is life-threatening if untreated. Long-term follow-up is needed to detect repeated infections (recurrences).

Possible Complications

Untreated, the disease can cause any of the following:

When to Contact a Medical Professional

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 cry
  • Irritability
  • Persistent unexplained fever

Call the local emergency number if you develop any of the serious symptoms listed above. Meningitis can quickly become a life-threatening illness.

Prevention

Treating people who have signs of a non-active (dormant) tuberculosis infection can prevent the spread of tuberculosis. A PPD test and other tuberculosis tests can be done to tell if you have this type of infection.

Some countries with a high incidence of TB give people a vaccine called BCG to prevent TB. But, the effectiveness of this vaccine is limited and it is not usually used in the United States. The BCG vaccine may help prevent severe forms of tuberculosis, such as meningitis, in very young children who live in areas where the disease is common.

References

Ellner JJ. Tuberculosis. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 332.

Fitzgerald DW, Sterling TR, Haas DW. Mycobacterium tuberculosis. In: Bennett JE, Dolin R, Blaser MJ, eds. Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2015:chap 251.

Swartz MN. Meningitis: bacterial, viral, and other. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 360.

Thwaites GE, van Toorn R, Schoeman J. Tuberculous meningitis: more questions, still too few answers. Lancet Neurol. 213;12:999-1010. PMID 23972913 www.ncbi.nlm.nih.gov/pubmed/23972913.


Review Date: 12/7/2014
Reviewed By: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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