Tuberculous meningitis
You don't need to be Editor-In-Chief to add or edit content to WikiDoc. You can begin to add to or edit text on this WikiDoc page by clicking on the edit button at the top of this page. Next enter or edit the information that you would like to appear here. Once you are done editing, scroll down and click the Save page button at the bottom of the page.
| Tuberculous meningitis Classification and external resources | |
| ICD-10 | A17.0, G01. |
|---|---|
| ICD-9 | 013.0, 322.9 |
| eMedicine | neuro/385 |
| MeSH | D014390 |
Please Take Over This Page and Apply to be Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [1] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.
Tuberculous meningitis is also called "TB meningitis".
Tuberculous meningitis is Mycobacterium tuberculosis infection of the meninges. It is the most common form of CNS tuberculosis.
Clinical features
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.
Pathology
Mycobacterium tuberculosis of the meninges is the cardinal feature and the inflammation is concentrated towards the base of the brain. Infection begins in the lungs and may spread to the meninges by a variety of routes.
Blood-borne spread certainly occurs and 25% of patients with miliary TB have TB meningitis, presumably by crossing the blood-brain barrier[1]; but a proportion of patients may get TB meningitis from rupture of a cortical focus in the brain (a so-called Rich focus); an even smaller proportion get it from rupture of a bony focus in the spine. It is rare and unusual for TB of the spine to cause TB of the central nervous system, but isolated cases have been described.
Diagnosis
Diagnosis of TB meningitis is made by analysing CSF collected by lumbar puncture. When collecting CSF for suspected TB meningitis, a minimum of 1ml of fluid should be taken (preferably 5 to 10ml).
The CSF usually has a high protein, low glucose and a raised number of lymphocytes. Acid-fast bacilli are sometimes seen on a CSF smear, but more commonly, M. tuberculosis is grown in culture. A spiderweb clot in the collected CSF is characteristic of TB meningitis, but is a rare finding.
More than half of cases of TB meningitis cannot be confirmed microbiologically, and these patients are treated on the basis of clinical suspicion only. The culture of TB from CSF takes a minimum of two weeks, and therefore the majority of patients with TB meningitis are started on treatment before the diagnosis is confirmed.
Nucleic acid amplification tests (NAAT)
This is a heterogeneous group of tests that use polymerase chain reaction (PCR) to detect mycobacterial nucleic acid. These test vary in which nucleic acid sequence they detect and vary in their accuracy. The two most common commercially available tests are the amplified mycobacterium tuberculosis direct test (MTD, Gen-Probe) and Amplicor. In 2007, a systematic review of NAAT by the NHS Health Technology Assessment Programme concluded that for diagnosing tuberculous meningitis "Individually, the AMTD test appears to perform the best (sensitivity 74% and specificity 98%) [page 87]" [1]. In the NHS meta-analysis, they found the pooled prevalence of TB meningitis to be 29% [page 85]; however there was much heterogeneity in the reported sensitivities. Using a clinical calculator, these numbers yield a positive predictive value of 94% and a negative predictive value of 90%; however the 30% prevalence may be high due to referral bias. Alternate estimates of disease prevalence can be entered into the clinical calculator to refine the predictive values.
Imaging
Imaging studies such as CT or MRI may show features strongly suggestive of TB meningitis, but cannot diagnose it.
Treatment
The treatment of TB meningitis is isoniazid, rifampicin, pyrazinamide and ethambutol for two months, followed by isoniazid and rifampicin alone for a further ten months. Steroids are always used in the first six weeks of treatment (and sometimes for longer). A few patients may require immunomodulatory agents such as thalidomide.
Treatment must be started as soon as there is a reasonable suspicion of the diagnosis. Treatment must not be delayed while waiting for confirmation of the diagnosis.
Hydrocephalus occurs as a complication in about a third of patients with TB meningitis and will require a ventricular shunt.
References
WikiDoc Research Resources for Tuberculous meningitis (Click show to right to view) | |
|---|---|
| Articles on Tuberculous meningitis | Most recent articles on Tuberculous meningitis • Most cited articles on Tuberculous meningitis • Review articles on Tuberculous meningitis • Articles on Tuberculous meningitis in N Eng J Med, Lancet, BMJ |
| Media (Slides, Video, Images, MP3) on Tuberculous meningitis | Powerpoint slides on Tuberculous meningitis • Images of Tuberculous meningitis • Photos of Tuberculous meningitis • Podcasts & MP3s on Tuberculous meningitis • Videos on Tuberculous meningitis |
| Evidence Based Medicine Regarding Tuberculous meningitis | Cochrane Collaboration on Tuberculous meningitis • Bandolier on Tuberculous meningitis • TRIP on Tuberculous meningitis |
| Cost Effectiveness of Tuberculous meningitis | Cost Effectiveness of Tuberculous meningitis |
| Clinical Trials Involving Tuberculous meningitis | Ongoing Trials on Tuberculous meningitis at Clinical Trials.gov • Trial results on Tuberculous meningitis • Clinical Trials on Tuberculous meningitis at Google |
| Guidelines / Policies / Government Resources (FDA/CDC) Regarding Tuberculous meningitis | US National Guidelines Clearinghouse on Tuberculous meningitis • NICE Guidance on Tuberculous meningitis • NHS PRODIGY Guidance • FDA on Tuberculous meningitis • CDC on Tuberculous meningitis |
| Textbook Information on Tuberculous meningitis | Books and Textbook Information on Tuberculous meningitis |
| Pharmacology Resources on Tuberculous meningitis | Dosing of Tuberculous meningitis • Drug interactions with Tuberculous meningitis • Side effects of Tuberculous meningitis • Allergic reactions to Tuberculous meningitis • Overdose information on Tuberculous meningitis • Carcinogenicity information on Tuberculous meningitis • Tuberculous meningitis in pregnancy • Pharmacokinetics of Tuberculous meningitis • |
| Genetics, Pharmacogenomics, and Proteinomics of Tuberculous meningitis | Genetics of Tuberculous meningitis • Pharmacogenomics of Tuberculous meningitis • Proteomics of Tuberculous meningitis |
| Newstories on Tuberculous meningitis | Tuberculous meningitis in the news • Be alerted to news on Tuberculous meningitis • News trends on Tuberculous meningitis |
| Commentary on Tuberculous meningitis | Blogs on Tuberculous meningitis |
| Patient Resources on Tuberculous meningitis | Patient resources on Tuberculous meningitis • Discussion groups on Tuberculous meningitis • Patient Handouts on Tuberculous meningitis • Directions to Hospitals Treating Tuberculous meningitis • Risk calculators and risk factors for Tuberculous meningitis |
| Healthcare Provider Resources on Tuberculous meningitis | Symptoms of Tuberculous meningitis • Causes & Risk Factors for Tuberculous meningitis • Diagnostic studies for Tuberculous meningitis • Treatment of Tuberculous meningitis |
| Continuing Medical Education (CME) Programs on Tuberculous meningitis | CME Programs on Tuberculous meningitis |
| International Resources on Tuberculous meningitis | Tuberculous meningitis en Espanol • Tuberculous meningitis en Francais |
| Business Resources on Tuberculous meningitis | Tuberculous meningitis in the Marketplace • Patents on Tuberculous meningitis |
| Informatics Resources on Tuberculous meningitis | List of terms related to Tuberculous meningitis |
| ||||
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
