Description and causes of the disease
Tuberculous meningitis is an extrapulmonary form of tuberculosis, in which the meninges are affected by mycobacteria of tuberculosis. In other words, it is meningitis tuberculosis. With a complication of meningitis, tuberculous meningoencephalitis is diagnosed, which is often accompanied by HIV infection.
Note! A similar diagnosis was first made in 1893.
Previously, the disease was more commonly detected in children under 5 years of age and adolescents. Currently, pathology is found equally in both adults and children. The risk of developing the disease is especially high in the following groups of people:
- children with weakened immune status, who have a delay in psychophysical development;
- people with addiction to alcohol, drugs;
- elderly people;
- adults with weakened immune defenses.
The most common cause of pathology is a weakened immune system. Tuberculosis in any form, head injuries, infections, and intoxication of the body affect the development of the disorder.
The causative agent of pathology are strains of tuberculosis bacilli, which are highly resistant to environmental effects – Koch’s bacillus, which is resistant to an acidic environment.
The disease is accompanied by meningeal syndrome – stiff neck, provoking intolerable headaches. Muscular rigidity is manifested at the initial stage of the disease, while the patient constantly tilts his head back, only then does the pain subside. The patient also has no opportunity to tilt his head forward, can not bend the leg bent at the knee joint.
Tuberculous meningitis is transmitted by droplets when kissing, sneezing, coughing. There is also a hematogenous pathway: from the source of infection through the blood.
Mycobacteria enter the cells of the nervous system and brain tissue through blood. At first, the bacteria infect the capillaries of the soft sheath, then the spinal fluid, where inflammatory foci are formed. At last, the brain substance is affected.
Penetrating into the body, the strains provoke inflammation of fibrous and serous tissue structures, in which growths are formed, and capillaries of the brain atrophy. Cicatrization of the gray matter is fixed, in children there is stagnation of fluid. If the blood cells, phagocytes, cannot absorb the pathogen, then the rapid progression of meningitis begins. Affected vessels and tissue structures of the brain.
In children, the disease is usually formed primarily or against the background of infection. In infants up to one year, the pathology is severe and can be fatal. This is due to the incomplete formation of the immune response and the unreliable barrier between the tissues and blood cells. That is why pediatricians recommend vaccination, which forms resistance to strains of tuberculosis (BCG), in the first month of a newborn’s life.
In adults, pathology develops a second time, against the background of tuberculosis, it proceeds smoothly. Usually, TB strains are primarily localized in the lungs. If the location of the disease is not determined, isolated meningitis is diagnosed. Most often, the tuberculosis form develops as a result of mycobacterium tuberculosis of the lungs, bones, genitals, kidneys, and mammary glands.
Depending on the localization of the process and the degree of its development, meningitis is divided into basal, serous and cerebrospinal. In the basal form of the disease, the nerves of the skull are affected. The meningeal syndrome occurs in severe form. The treatment prognosis is favorable.
Serous meningitis causes fluid to build up at the base of the brain. Symptoms of pathology are mild. This form is treatable without causing complications.
Cerebrospinal view, or meningoencephalitis, leads to a softening of the tissue structure of the brain, hemorrhages. This form of the disease is characterized by a severe course and causes relapses. Treatment only helps in 50% of cases. For those people who have overcome the disease, motor impairment, hydrocephalus, and mental disorders remain incurable.
Signs of meningitis appear differently, based on the degree of disease progression:
- Prodromal stage. Lasts for a week or two. A person becomes irritable, lethargic, there is a headache, general malaise. The patient’s temperature slightly rises, develops vomiting. Since the symptoms are common, it is impossible to suspect tuberculous meningitis.
- Irritation. The duration of the period is 2 weeks. Fixed rapid development of signs of the disease. High sensitivity to external stimuli appears. Because of the dysfunction of the autonomic system, skin rash appears. Consciousness is disturbed, pain arises in the back of the head. A person’s condition is deteriorating dramatically.
- The terminal period. Because of the disruption of the functioning of the nerve processes, convulsive syndrome and paralysis appear. Sensory, cardiac and respiratory activity is impaired. Body temperature can rise sharply or become below normal. In the absence of therapy, the patient dies due to paralysis of the brain stem.
The described symptoms appear gradually due to a slow increase in intracranial pressure. Since inflammation does not occur immediately, meningeal syndrome develops after a week after infection.
The syndrome is also manifested by excessive sweating, drooling, difficulty breathing, and irregular blood pressure. If the doctor reveals meningeal syndrome, the diagnosis will be greatly facilitated.
For meningitis, you need to contact a phthisiologist, a neurologist, a pulmonologist. Neurologists and phthisiologists conduct joint diagnostics. Doctors need to differentiate tuberculous meningitis from normal. The difficulty in identifying pathology lies in the absence of specific characteristic symptoms.
Timely diagnosis increases the chances of a complete cure – the detection of meningitis in the first 15 days after infection.
For the diagnosis it is necessary to examine the entire body. To make a complete clinical picture, doctors may need data from fluorography, tests for tuberculosis, MRI. The state of the lymph nodes is also evaluated, an ultrasound scan of the spleen, liver is performed. Lumbar puncture is the dominant diagnostic method. A spinal fluid sample is taken for the study, which shows the exact result even at the initial stage of the disease.
How to treat a disease
Treatment of meningitis tuberculosis is carried out in intensive care units in tuberculosis dispensaries. It is important to constantly monitor the level of arterial indicators and the frequency of heart contractions. Also, doctors evaluate the concentration of oxygen in the blood. Oxygen saturation is performed using a mask.
For the treatment of pathology, anti-tuberculosis drugs are prescribed: Pyrazinamide, Isoniazid, Ethambutol. Initially, intravenous administration of medication is necessary, then oral administration.
The treatment is complemented by the use of neurological drugs: Dextran, Furosemide. In the presence of disorders in the functioning of the optic nerve, it is necessary to take Pyrogenal, Papaverine. In the latter stages of the disease, hormone therapy is required.
Tuberculous meningitis in children is treated with Prednisolone, which has an anti-inflammatory effect. It is also necessary to introduce vitamin and immunomodulatory agents. To reduce the degree of intoxication of the body, shown receiving diuretics.
Important! Doctors monitor therapeutic efficacy through the collection and examination of spinal fluid.
In the first months of treatment, the patient must comply with bed rest, with time it is allowed to walk. After the 5th month of therapy, massage, physiotherapy, and physiotherapeutic procedures are prescribed.
It is also important to adjust the diet. The menu should not contain fatty foods. It is recommended to eat fractional, fresh vegetables, white meat, seafood should prevail.
After treatment, the patient is sent to a sanatorium, after staying in which the patient is observed for several years, regularly conducting routine diagnostics. Also requires rehabilitation by a neurologist, an ophthalmologist, a speech therapist.
Consequences and prognosis
Before the invention of anti-tuberculosis drugs, people with meningitis died on the 3rd week of the disease. Currently, the therapeutic effect is observed in 90% of patients subject to early diagnosis. Tuberculous meningitis in case of late detection can lead to:
- infectious and toxic shock;
- epileptic seizures;
- disruptions in the neuroendocrine system;
- impaired vision and hearing;
- of death.
With well-chosen therapy, a positive effect occurs in almost all patients.
To prevent the development of meningitis, annual preventive examinations are required, such as fluorography, x-rays, blood tests, and Mantoux tests. It is important for children to be vaccinated against tuberculosis in time. It is important to adhere to sanitary rules. Physicians should monitor the risk groups and isolate the infected.
Tuberculous meningitis is a serious disease that requires early detection. The earlier the disease is diagnosed, the greater the chances of a successful recovery without relapse.