Tuberculosis is capable of affecting most organs and systems in the human body, and the central nervous system is not an exception. And although in recent years the disease is diagnosed at earlier stages, the treatment methods have become more sophisticated, and the death rate from it has significantly decreased, tuberculosis meningitis presents a great danger today.
What is tuberculous meningitis
Tuberculous meningitis is primarily a secondary inflammation of the meninges, which usually occurs in patients with various forms of tuberculosis. Among the patients are more often children under 5 years, adolescents, elderly people, as well as patients with immunodeficiency. Outbreaks of the disease are observed in the winter-spring period, although the risk of infection also persists throughout the calendar year.
Pathogenesis
Let's talk about how tuberculous meningitis is transmitted.
The causative agent is mycobacterium tuberculosis( MBT).This means that the emergence of tuberculosis of the meninges and its development occurs only if the body already has a tuberculous lesion of any organ or system. Only 3% of patients failed to establish a primary focus of the disease.
Infection occurs in 2 stages:
- through the blood of : granuloma is formed, caused by the defeat of the vascular plexus of the ventricles;
- liquorogenic spread of : MBT reach the base of the brain, infecting the meninges and causing allergy in the vessels, manifested by acute meningeal syndrome.
Reasons for
The main cause of the disease is the defeat of any organ of the patient with mycobacterium tuberculosis. The tuberculosis bacillus enters the cerebrospinal fluid with blood, is placed on the mild cerebral membrane and proceeds to reproduction, which leads to the development of tuberculous meningitis.
Symptoms of the disease
Characteristic features of the symptoms of tuberculous meningitis is a gradual onset with a prolonged prodromal period( up to 6 weeks), during which it is possible to note some change in the patient's mental status.
Namely:
- apathy;
- increased irritability;
- fatigue;
- worsening of sleep;
- lack of appetite;
- occurrence of daily headaches( usually in the evenings).
At the same time, the general condition can be considered normal, for the first time the patient even continues his professional activity. However, the intensity of the headache increases( vomiting often occurs), the body temperature rises, the general condition worsens significantly, the patient can no longer lead a normal life and consults a doctor.
If a doctor reveals the presence of a meningeal syndrome, the likelihood of a correct diagnosis is high.
Meningeal syndrome is the stiff neck muscles, strong( almost intolerable) headaches and Kernig symptom.
Neck stiffness refers to a fairly early symptom of the disease. It manifests itself by throwing the head back to the patients, and any change in this position is given by severe pain. This problem is observed throughout the period of the disease.
The Kernig symptom is characterized by the impossibility of unbending the leg in the knee, provided that it is bent at the knee and hip joints. And if you try to bend the patient's leg in the hip joint with the knee flexed, he simultaneously bends it in the knee joint.
Disorders accompanying meningeal syndrome:
- secretory disorders( increased salivation and sweating);
- breathing disorder;
- fluctuations in blood pressure;
- elevated temperature( up to 40 ° C);
- intolerance of noise and photophobia. Patients lie with closed eyes, do not talk, they try to answer questions in monosyllables;
- in the late stages - confusion and coma, body temperature can rise to 41-42 ° C or, conversely, decrease to 35 ° C, the pulse reaches 200 beats per minute, breathing is arrhythmic.
Classification of tuberculous meningitis
Depending on the prevalence and localization of the pathological process, 3 clinical types of tuberculousMeningitis:
- basal ( basilar);
- cerebrospinal meningoencephalitis;
- serous tuberculous meningitis.
Basilic meningitis affects the cranial nerves. The meningeal symptom is expressed, at the same time, intellectual disorders are not noted. The course of the disease is quite severe, there is a possibility of exacerbations. The outcome in the treatment is favorable.
Meningoencephalitis leads to hemorrhages and softening of the brain. The course of this form of the disease is severe, and the likelihood of relapse is also high. In 50% of cases, the outcome is unfavorable. And even in half of the recovered there are motor disorders( paresis of limbs), mental disorders and hydrocephalus phenomena.
In the serous type of tuberculous meningitis, an accumulation of exudate( a transparent fluid containing cells of serous membranes) is observed at the base of the brain. Meningeal syndrome is mild. The outcome is favorable, this form proceeds usually without complications and relapses.
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Diagnostics
Diagnostics of cerebrospinal fluid is important in diagnosis. The likelihood of tuberculous meningitis is high, if the puncture:
- spinal fluid is clear, flows out with droplets, its pressure is increased;
- protein content is above normal;
- the glucose content is lower.
- At the same time, the blood picture remains almost unchanged.
Obligatory in the diagnosis:
- chest X-ray;
- tuberculin test.
MRI or CT scan may reveal hydrocephalus, a cerebral infarction or tuberculosis.
Methods of treatment
Various combinations of antituberculous drugs are used. In the first two months, "Pyrazinamide", "Rifampicin", "Isoniazid" and "Etambutol" are usually prescribed( the exact scheme is developed by the attending physician).
After determining the sensitivity to these drugs, treatment is adjusted. After 2-3 months, they switch to the use of two drugs( Isoniazid and Rifampicin).
In the early stages to prevent complications, it is advisable to use glucocorticoids. However, any doctor may change the treatment plan.
The first 2 months are of decisive importance in treatment. The total duration of treatment is 12-18 months.
Complications and prognosis of
Before the introduction of anti-tuberculosis drugs in medicine, the illness ended in a lethal outcome at the 2-3 rd week. Today, a positive result with timely diagnosis occurs in 90% of patients. But with late diagnosis( after the 18th day), the consequences of tuberculosis meningitis can be deplorable.
The most common complication is a hydrocephalus of the brain( hydrocephalus), which is associated with the development in the brain envelopes of the adhesion process and sclerotic changes. Sometimes there are complications in the form of epileptic seizures.
Preventive measures
To preventive measures include:
- providing a separate isolated living space for patients with tuberculosis, living in apartment buildings or dormitories;
- early diagnosis - will help reduce the incidence of people coming into contact with patients;
- timely vaccination of newborns( up to 30 days of life), etc.
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Dispensary follow-up
After returning home, meningitis of the meninges has been observed for 2-3 years. The issue of their ability to work is put at least a year after the end of treatment in the hospital.
In the presence of residual phenomena( expressed), the cured are considered needy in constant care and professionally incapacitated, in the absence of such phenomena - incapacitated, but without the need for extraneous care.
In the absence of residual events and other contraindications, it is possible to raise the question of returning to professional activity.
And the timely diagnosis is of great importance for a successful cure. Remember this and be attentive to yourself!
Video, which tells about what is dangerous meningitis:
http: //youtu.be/ -QMbq2lkLcM