Mycobacterium tuberculosis Meningitis: A Report of Twelve Cases and a Literature Review

Abstract

Twelve recent cases of Mycobacterium tuberculosis meningitis were presented, and the literature was reviewed. There are no particularly new or unique therapies or approaches to the management of this most serious disease. The major obstacle to successful diagnosis and treatment of tuberculous meningitis continues to be a lack of clinical suspicion of its presence. As illustrated in the cases presented, it has been our experience that patients already moribund or nonresponsive do not respond, regardless of the intervention undertaken. The most sensitive and economical method of detecting M. tuberculosis in the CSF may be LPA. However, this has not yet been widely validated or accepted. Larger volumes of CSF should be sent to the laboratory for testing and centifuged to about 5x concentrations before both acid-fast bacilli staining and culture are attempted. If tuberculous meningitis is suspected, three-drug therapy can be started immediately without jeopardizing subsequent culture confirmation of the presence of the TB bacillus. In addition, these patients must be followed closely to detect hydrocephalus at the earliest possible moment. When patients fail to respond to appropriate antituberculosis and pressure-reducing therapy, hydrocephalus should be actively sought by either CT or radioisotope cisternography. Although the decision to proceed to ventricular drainage or shunting must be individually made in adult patients with infection-related hydrocephalus, we agree with others that surgical intervention should be considered early and should be performed if the level of consciousness deteriorates, intracranial pressure increases, or ventricular enlargement or enhancing basal exudates are identified on CT.

Tuberculous Meningitis: Diagnosis and Treatment Overview

“…Hydrocephalus is a common complication of TBM; prevalence has been documented in >75% of patients in several published series [65, 66]. Ventriculoperitoneal shunt placement and endoscopic third ventriculostomy are surgical techniques which have been demonstrated to relieve elevated intracranial pressure (ICP) in TBM, leading to improved neurological outcomes [67, 68].…”

A Case of Tuberculous Meningitis Presenting with Atypical Cerebrospinal Fluid Findings

“…In a previous study by Jeren and Beus [5], the CSF findings of 84 cases with tuberculous meningitis were evalu ated, and the authors report that glucose and chloride levels were normal in a number of cases, but the protein levels were always in creased. In another series, it was reported that 17% of the cases had normal levels of CSF glucose and 25% of the cases had CSF protein levels <100 mg/dl [3], It is known that the chloride concentration CSF is dependent on the concentration of protein in the spinal fluid [6], Our patient's Cl values were normal. On admission, examination of CSF re vealed 140 WBCs with 80% mononuclear cells.…”

Hydrogel-coated ventricular catheters for high-risk patients receiving ventricular peritoneum shunt

“…Hydrocephalus can be attributed to various factors, including CSF infection, [20,21] primary meningitis, and the post-surgery infection of a series of neurosurgical diseases. According to Arunodaya's study, [22] the post-neurosurgery nosocomial wound infection rate is 6.9%.…”