Tuberculous meningitis - Causes, symptoms and treatment. MF.
Jun 13, 2018
Tuberculous meningitis is primarily a secondary tuberculosis lesion( inflammation) of the meninges( soft, spider and less often hard) that occurs in patients with various forms of tuberculosis of other organs.
Image of the inflamed brain( incision) with meningitis
Causes of tuberculous meningitis
The risk factors for the development of the disease are: age( reduced immune defense of the organism), seasonality( often fall in the spring and autumn), concomitant infections, intoxication, traumatic brain injury.
Tuberculosis inflammation of the meninges occurs when the mycobacterium directly enters the nervous system due to a vascular barrier disruption. This occurs as a result of hypersensitivity of cerebral vessels, membranes, vascular plexuses, as a result of the above-mentioned conditions.
Symptoms of tuberculous meningitis
More often the disease begins gradually, but there are also acute progressive cases( more often in children).
The disease begins with malaise, headache, periodic fever( no more than 38), impaired mood in children. During the first week there is sluggishness, appetite is lowered, constant headache, fever.
Then the headache becomes more intense, vomiting occurs, increased excitability, anxiety, weight loss, constipation. There are paresis of the facial, oculomotor and distracting nerves.
Characteristic: bradycardia( slow pulse - less than 60 beats per minute), arrhythmia( heart rhythm disturbances), photophobia.
There are changes in the eyes: neuritis( inflammation) of the optic nerves, tuberculous tubercles, which the phthisiatrist sees).
After 2 weeks, if treatment is not started, the temperature rises to 40, the headache persists, there is a forced posture, a blackout of consciousness. There are: paralysis, paresis( disruption of the motor activity of the limbs, face), cramps, dry skin, tachycardia( more than 80 per minute), cachexia( weight loss).
After 3-5 weeks without treatment, death occurs as a result of paralysis of the respiratory and vasomotor centers.
The most common form of tuberculous meningitis is basal tuberculous meningitis .This form is characterized by pronounced cerebral meningeal symptoms( clinical signs of irritation of the meninges, it occurs as rigidity of the occipital muscles - not the ability to lead the chin to the breast and other neurological symptoms), violation of cranial cerebral innervation and tendon reflexes( muscle contraction in response to rapid stretching ormechanical irritation of tendons, for example, when a neurological hammer strikes it).
The most severe form is the tuberculous meningoencephalitis .There are cerebral( vomiting, confusion, headache) and meningeal symptoms, focal( depending on the lesion of this or that part of the brain, for example: gait unsteadiness, paralysis of the extremities, etc.), as well as disorders of craniocerebral innervation,hydrocephalus.
is a rare case of tuberculous leptopachimeningitis .Characteristic gradual malosymptomnoe beginning.
If the above symptoms occur, urgent inpatient treatment is needed. Terms depend on the form of the process, severity. Treatment can last up to half a year or more.
Analyzes for suspicion of tuberculous meningitis
In the general blood test there is an increase in the rate of erythrocyte sedimentation, leukocytosis, lymphopenia, shift of the leukocyte formula to the left.
The main method of diagnosis of tuberculous meningitis is the examination of cerebrospinal fluid after spinal puncture. The number of cells( pleocytosis) is increased, lymphocytes predominate. The level of protein is also increased, the composition changes in the direction of increasing globulins. Positive reaction of Pandi and Nonne-Appelt. In biochemical research, a decrease in glucose levels is detected. The cerebrospinal fluid is colorless, transparent, opalescent, in more severe cases - yellowish, when standing in a test tube, a tender fibrin film is formed.
Sowing is performed on mycobacterium tuberculosis, with this type of examination they are detected in 15% of cases. Also, PCR is performed - up to 26% of cases are detected. Using the ELISA, antibodies to mycobacteria of tuberculosis can be detected.
Recently used computerized tomography of the brain and magnetic resonance. Also in the complex, it is necessary to examine the lungs( X-ray, CT, MRI) and other organs, to exclude the associated pathology. Tuberculosis meningitis is rarely identified as the only lesion of the tuberculosis process. Currently, mixed infections predominate: tuberculosis and fungus, tuberculosis and herpes, etc.
The disease is differentiated from meningitis of a different nature.
Treatment of tuberculous meningitis
Treatment is only inpatient, if the above symptoms occur, the patient is hospitalized. Treatment lasting: from a year or more.
The main drugs: isoniazid, rifampicin, ethambutol, pyrazinamide. Treatment is carried out according to the same schemes as any form of the tuberculosis process.
Symptomatic treatment: antioxidants, antihypoxants, nootropics - cinnarizine, nootropil( improve cerebral blood flow).Assign diuretic( diacarb, lasix) - prevention of cerebral edema. Detoxification therapy( glucose, saline).
Nutrition for tuberculous meningitis
The diet requires high protein: meat, fish, dairy products, milk. Limit the intake of liquid to a liter a day. Limit the amount of table salt.
Treatment with folk remedies
For this pathology, it is better to limit oneself to the appointments of the attending physician so that severe, incurable consequences do not arise.
Rehabilitation after treatment
Rehabilitation depends on the severity of the process. Includes exercise therapy, restorative massage, possibly sanatorium treatment.
Complications of tuberculous meningitis
Complications such as cerebrospinal outflow block, hydrocephalus( a disease characterized by the accumulation of cerebrospinal fluid in the brain ventricles), hemiparesis( paralysis of the muscles of one half of the body), visual impairment, and occasionally to complete loss of it. With the spinal form, paresis of the extremities, disorders of the pelvic organs are possible.
With the timely access for medical care, treatment in most patients there is a complete recovery. Death in 1% of cases with late treatment and treatment, especially with meningoencephalitic form.
Prevention of tuberculous meningitis
In children, this disease may occur after contact with a bacteriovirus( in adults less often).Also, in children not vaccinated with BCG or in the absence of postvaccinal scars, who have not received chemoprevention after detection of the bend of the tuberculin reaction, especially if there are concomitant diseases.
And general recommendations: you must avoid hypothermia, prolonged exposure to the sun, observe the treatment of chronic diseases.
Doctor phthisiatrist Kuleshova LA