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tuberculous meningitis
see meningitis
Etiology:
- meningitis due to tuberculosis
Clinical manifestations:
- basilar meningitis
- cranial neuropathy
- mental status change
- SIADH
Laboratory:
- cerebrospinal fluid
- WBC < 300/mm3, predominantly lymphocytes
- CSF protein 100-300 mg/dL
- CSF glucose < 40 mg/dL or may be normal
- Mycobacterium tuberculosis DNA in CSF
Differential diagnosis:
- listeriosis
- fungal meningitis
Management:
1) empiric coverage for bacterial meningitis including listeriosis until diagnosis of tuberculous meningitis confirmed
- ceftriaxone, vancomycin, ampicillin [4]
2) isoniazid
a) 15-20 mg/kg/day (max 500 mg/day) in children
b) 8-10 mg/kg/day (max 300 mg/day) in adults c)] QD or BID
3) rifampin
a) 15-20 mg/kg/day (max 600 mg/day)
b) QD or BID
4) 6-9 months of therapy [3]; 1 year of therapy MKSAP [2]
5) dexamethasone for 4-6 weeks may be of benefit [1]
General
bacterial meningitis
tuberculosis
References
- Journal Watch 24(24):185, 2004
Thwaites GE, Nguyen DB, Nguyen HD, Hoang TQ, Do TT, Nguyen TC,
Nguyen QH, Nguyen TT, Nguyen NH, Nguyen TN, Nguyen NL,
Nguyen HD, Vu NT, Cao HH, Tran TH, Pham PM, Nguyen TD,
Stepniewska K, White NJ, Tran TH, Farrar JJ.
Dexamethasone for the treatment of tuberculous meningitis in
adolescents and adults.
N Engl J Med. 2004 Oct 21;351(17):1741-51.
PMID: 15496623
- Medical Knowledge Self Assessment Program (MKSAP) 16, 18, 19
American College of Physicians, Philadelphia 2012, 2018, 2021
- American Thoracic Society; CDC;
Infectious Diseases Society of America.
Treatment of tuberculosis.
MWR Recomm Rep. 2003 Jun 20;52(RR-11):1-77
PMID: 12836625
- Bhimraj A.
Acute community-acquired bacterial meningitis in adults: an
evidence-based review.
Cleve Clin J Med 2012 Jun 5; 79:393
PMID: 22660870
- Prasad K, Singh MB, Ryan H.
Corticosteroids for managing tuberculous meningitis.
Cochrane Database Syst Rev. 2016 Apr 28;4:CD002244. Review.
PMID: 27121755 Free PMC Article