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Meningitis - tuberculous

Definition

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

See also:

Alternative Names

Tubercular meningitis; TB meningitis

Causes, incidence, and risk factors

Tuberculous meningitis is caused by Mycobacterium tuberculosis, the bacteria that cause tuberculosis. The bacteria spread to the brain from another site in the body.

Risk factors include a history of:

Tuberculous meningitis is a very rare disorder in the U.S.

Symptoms

The symptoms usually begin gradually, and may include:

Other symptoms that can occur with this disease:

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

Signs and tests

Physical examination will usually show:

  • Fast heart rate
  • Fever
  • Mental status changes
  • Stiff neck

For any patient who is suspected of having meningitis, it is important to perform a lumbar puncture ("spinal tap"), in which spinal fluid (known as cerebrospinal fluid, or CSF) is collected for testing. When the health care provider suspects tuberculous meningitis, more than one CSF sample may be needed to make the diagnosis.

Tests that may be done include:

Treatment

Treatment involves several antitubercular drugs at the same time, as it does for pulmonary tuberculosis. Treatment sometimes must begin if the diagnosis is only suspected, not proved, in order to save a person's life.

Treatment usually lasts for at least 12 months. Systemic steroids may also be used.

Expectations (prognosis)

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

Complications

Calling your health care provider

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

In areas where tuberculosis is more common, the BCG vaccine may help prevent severe forms of tuberculosis, such as meningitis, in very young children.

Treating people who have evidence of a non-active (dormant) tuberculosis infection can prevent the spread of tuberculosis. A dormant infection can be detected by a positive PPD.

References

Iseman MD. Tuberculosis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 345.

Swartz MN. Meningitis: bacterial, viral, and other. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 437.


Review Date: 9/15/2010
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, University of Washington School of Medicine; and Jatin M. Vyas, PhD, MD, Assistant Professor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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