Meningeal Tuberculosis

Meningeal Tuberculosis (MTB) is a bacterial infection caused by Mycobacterium tuberculosis. The bacteria are transmitted through direct contact with infected secretions or contaminated objects such as needles, syringes, or clothing. Symptoms of TB include fever, headache, chills and weakness. If left untreated it may lead to pneumonia and death from complications like sepsis. There are several strains of MTB. They differ in their ability to cause disease, but all have been shown to be highly infectious. The most common strain is M. bovis which causes active pulmonary infections in humans and animals. Other strains are less contagious and do not cause disease at all in healthy individuals, but they can spread easily among groups of people who share infected objects or equipment, or even between people if they come into contact with each other’s droplets during coughing fits.

The main symptom of TB is a high temperature, usually over 102°F (38.8°C). However, some patients experience other symptoms including: cough, shortness of breath, chest pain or discomfort; fatigue; nausea and vomiting; diarrhea; abdominal cramps and bleeding from the nose and mouth.

Some people develop no symptoms at all. The illness progresses rapidly in those who don’t receive medical care immediately after exposure to the bacteria.

Tuberculosis is a curable disease. The exact treatment will depend on many factors including the age and immune system of the patient, the drug-sensitivity of the strain causing the infection and whether both lungs or other organs are affected. Antibiotics may either be given on their own, or alongside chemotherapy drugs such as rifampin, isoniazid, pyrazinamide and others.

It is also possible to vaccinate against some strains of tuberculosis.

There are about 1 billion people infected with tuberculosis, according to WHO. In 2011, it caused about 1.4 million deaths and 117,000 of those were HIV-positive people.

Meningeal Tuberculosis

Meningeal Tuberculosis is a serious disease that affects the protective membranes covering the brain and spinal cord known as the meninges. It is caused by an infection of Mycobacterium tuberculosis. Meningeal Tuberculosis can cause a brain infection (called tuberculous meningitis) or a spinal cord infection (tuberculous myelitis).

Meningeal tuberculosis is uncommon in the United States and other developed countries. It most commonly occurs in developing countries where TB is more common.

Meningeal tuberculosis usually starts as a primary lung infection, and it only rarely spreads to the central nervous system. When it does spread to the nervous system, it tends to do so within two years of the original infection. Meningeal tuberculosis can also develop in people with no history of lung disease.

The reason is unknown.

The most common symptom of meningeal tuberculosis is headache, but symptoms also include fever, drowsiness, mood swings, irritability, and nausea or vomiting. Severe cases may also lead to a loss of appetite, altered consciousness, seizures and other neurological disorders.

There is no specific treatment for meningeal tuberculosis on its own; it must be treated in the same way as ordinary pulmonary tuberculosis. Antibiotics are taken for 18 months to three years. The choice of drug is based on the results of cultures and other laboratory tests.

In addition to antibiotics, doctors may recommend bed rest, a nutritious diet and stress reduction.

Meningitis

Meningitis is an inflammation of the protective membranes covering the brain and the spinal cord (called the meninges). It is most commonly caused by an infection, but it can also be caused by certain drugs or tumors. Meningitis can be a life-threatening condition.

Three main types of bacterial meningitis affect adults:

* Bacterial Meningitis (caused by any type of bacterial infection)

* Viral Meningitis (caused by viruses)

* Tuberculous Meningitis (caused by the bacteria Mycobacterium tuberculosis)

The symptoms of meningitis in adults are headache, fever, neck pain, vomiting, lack of appetite, and an overall feeling of ill health. The infection can spread to other parts of the body, most commonly the brain, spinal cord and the membranes that surround them. The symptoms of this are confusion, muscle weakness, loss of coordination and seizures.

The elderly and people with a weak immune system are at particularly high risk of serious complications from meningitis.

Diagnosis is typically made through a physical examination and a review of your health history. Your doctor may order blood tests to determine if you have an infection or a neurological disorder. A lumbar puncture (LP) also called a spinal tap is one of the most important tests to make the diagnosis of meningitis.

In some cases where the diagnosis is uncertain, a CT or MRI scan of the brain and spine may be done.

Treatment for meningitis typically involves extended courses (6 weeks to 3 months or more) of antibiotics. If the infection has spread to the nervous system, you may need to take antibiotics for up to six months. You may also need to take analgesics (painkillers) and anti-inflammatory drugs depending on the nature of your symptoms.

In some cases, surgery may be required to remove infected material from your brain or spine.

Meningitis is a serious infection and can be life-threatening if not diagnosed and treated promptly. It is particularly dangerous among the very young and the elderly. If you suspect that you or someone you know is suffering from meningitis, seek medical help immediately.

Fungal Meningitis

Meningitis is a serious brain and spinal cord infection that causes the membranes that surround your brain and spinal cord (called the meninges) to become inflamed. There are several different causes of this dangerous condition including bacteria and viruses, but fungal meningitis is extremely rare. Fungal meningitis can be difficult to treat and may require surgery in addition to medications and if you contract it, you may suffer permanent brain damage.

Bacterial Meningitis

Bacterial meningitis is caused by an infection of the protective membranes surrounding the brain and spinal cord (meninges). This type of meningitis can be life-threatening. It is typically caused by an infection spread from another person (contagious) or may come from an infection you’ve had for a long time that has become active again (invasive).

Viral Meningitis

Viral meningitis is caused by a virus that attacks the brain and spinal cord. This type of meningitis is contagious, but not usually life-threatening. While viruses are tiny, they are complex and only become active and contagious when they are released from the body (excrete) in bodily fluid such as saliva, nasal mucus, urine or stool.

Viruses can also be spread through blood or sexual contact.

Fungal Meningitis

Fungal meningitis is caused by a fungal infection of the protective membranes surrounding the brain and spinal cord (meninges). While less common than other causes, the tissue in the brain and spinal cord may attract certain types of fungus resulting in meningitis.

Invasive Fungus and Meningitis

Invasive fungus and meningitis is a very serious type of meningitis caused by a fungus called candida. This fungus is normally found on the skin or in the mouth, gastrointestinal tract or genitals. In very rare cases this fungus may spread throughout the body and reach the brain causing invasive meningitis.

This type of fungal meningitis is also known as candida meningitis, candida encephalitis or sometimes by its medical name of cryptococcal meningitis.

Signs and Symptoms of Fungal Meningitis

The first sign of fungal meningitis is typically a severe headache that develops suddenly. You may also experience neck stiffness, nausea and vomiting, fever, confusion, dizziness and even seizures or loss of consciousness. These symptoms may come on suddenly or develop over a few days.

The condition is life-threatening and requires immediate medical attention.

Treatment for Fungal Meningitis

The anti-fungal medication amphotericin B is typically given as an injection into your vein. It works to fight the infection by attacking the fungus cells. Other medications such as fluconazole, itraconazole or voriconazole may also be used and work by stopping the growth of the fungus.

Corticosteroids such as dexamethasone are sometimes used to reduce brain swelling caused by the infection. You will be hospitalized and put on a fast timetable to receive your medication. The length of your hospitalization will vary depending on your response to treatment.

Prevention of Fungal Meningitis

You cannot prevent a fungal meningitis infection as it is not contagious, but you can take steps to avoid other types including meningococcal disease caused by the bacteria Neisseria meningitidis and Haemophilus influenza.

With meningococcal disease you should get vaccinated for it. The vaccine is given in a series of shots and protects against most but not all strains of the bacteria. The vaccine is recommended for those at high risk of serious infection, this includes people with weakened immune systems, certain medical conditions and those in close contact with others who have the disease.

With Haemophilus influenza you should avoid close contact with those infected or exposed to the bacteria. The bacteria are spread through direct contact with respiratory secretions like saliva, nasal mucus and sputum (coughing or sneezing) of people with the disease.

With these diseases you should seek medical attention immediately if you or someone you know experiences the symptoms of meningitis, or if you cannot verify that everyone you have been in close contact with has been fully immunized against the disease.

Tuberculous Meningitis

Tuberculous meningitis is a serious illness caused by the bacteria called Mycobacterium tuberculosis. The infection leads to an inflammation of the membranes surrounding the brain and spinal cord. It is the most common form of meningitis (inflammation of the membranes surrounding the brain) in most parts of the world.

In most developed countries, tuberculosis is rare due to improvements in public health and hygiene. However, it is still a major cause of meningitis in Africa, Asia and Latin America. The disease is also common among people with weakened immune systems such as those infected with the human immunodeficiency virus (HIV).

Tuberculous meningitis can be transmitted from person to person through the air when an infected person coughs, sneezes or speaks. It is also possible to get it from infected body fluids such as saliva, nasal mucus, sputum (coughing or sneezing) and discharges from the eyes, mouth and genital tract.

Signs and Symptoms of Tuberculous Meningitis

The signs and symptoms of tuberculous meningitis are similar to other types of meningitis but more severe. They include:

Stiff neck

Fever

Sensitivity to light (photophobia)

Severe headaches (often described as the worst pain a person has ever felt)

Nausea and vomiting

Sleepiness (fatigue) or restlessness

Decreased appetite

Detached or blurry vision, double vision or drooping eyelids

Pain in the chest and/or bones, especially the ribs, and muscles of the chest wall.

Mental changes such as confusion, slurring of speech (mumbling), and agitated behaviour

Not all people infected with tuberculosis develop meningitis and the signs and symptoms vary among those who do. Some may have mild symptoms or may not experience any symptoms at all.

Diagnosing Tuberculous Meningitis

Anyone who has been exposed to someone with tuberculosis and who develops the symptoms described above should seek medical attention immediately. A chest x-ray and tests of the fluid drawn from the spinal column (lumbar puncture) are usually done to help with diagnosis.

Treatment of Tuberculous Meningitis

Treatment must be started immediately after the diagnosis to limit the risk of brain damage and death. Treatment usually involves taking antibiotics such as:

IV or IM streptomycin for the first two days

followed by

IV or IM kanamycin, rifampin, or amikacin for 15-20 days

Unfortunately, treatment with these drugs does not always kill the tuberculosis bacteria. Even after successful treatment of the meningitis itself, the bacteria may remain in other parts of the body, particularly the lungs and bones. Re-treatment may be necessary if the bacteria become active again.

Preventing Tuberculous Meningitis

The best way to prevent tuberculosis meningitis is to ensure that children receive regular vaccinations against this and other diseases. The vaccine is not 100% effective so anyone who develops TB meningitis has probably been a diabetic or had some other condition that reduced their body’s immune system function.

Treating Diabetes and Other Immune-Reducing Conditions

Anyone with a pre-existing condition that lowers the immune system’s ability to fight disease should be tested for tuberculosis. If positive, your health care professional will recommend treatment because this increases your risk of developing active tuberculosis.

Diabetes is the most common immune-reducing condition. Anyone with this condition should be tested for tuberculosis at least once a year. If you have diabetes, get regular check-ups from your health care professional to ensure that you receive all the necessary vaccines to protect yourself from potentially deadly diseases.

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