Chapter 2 transmission and pathogenesis of tuberculosis. Spinal cord involvement in tuberculous meningitis spinal. Tuberculous meningitis tbm is the most serious e xtrapulmonary manifestation of tuberculosis tb with mortality rates up to 50% observed in the context of hiv1 coinfection. Meningitis is an infection of the meninges, the membrane covering the brain. Study of tbm pathogenesis is hampered by a lack of experimental models that recapitulate all the features of the human disease. The diagnosis of tuberculous tb meningitis is difficult because the disease presents with unspecific. Pathogenesis and immune response in tuberculous meningitis. Multidrugresistant tuberculous meningitis in kwazulunatal, south africa. When collecting csf for suspected tb meningitis, a minimum of 1 ml of fluid should be taken preferably 5 to 10ml. Dissemination of tuberculosis to the brain results in the most severe form of extra pulmonary tb, tuberculous meningitis tbm, which.
There are different clinicalpathological manifestations of cerebral tb. Pathogenesis a discussion on the pathogenesis of tuberculous meningitis can be directed on two levels. A critical event in the pathogenesis of tbm is a tcell mediated inflammatory reaction induced by. Characteristic cerebrospinal fluid csf findings of tbm include a lymphocyticpredominant pleiocytosis, elevated protein, and low glucose. Tuberculous meningitis can cause significant permanent disability and high mortality, despite prompt administration of therapy. Tuberculousmeningitisautopsy, showing associated brain oedema and congestion diagnosis of tb meningitis is made by analysing cerebrospinal fluid collected by lumbar puncture. We also aim to look at the latest development of research of the disease. Pdf tuberculosis tb remains a leading cause of death globally. On a macroscopic level there are the mechanisms by which the tuberculous bacilli disseminate to the cns. Dissemination of tb to the brain results in the most severe form of extrapulmonary tb, tuberculous meningitis tbm, which represents a medical emergency associated with high rates of mortality and disability. Tuberculosis of the central nervous system postgraduate. Less common etiologies for aseptic meningitis include tuberculous meningitis mycobacterium tuberculosis, lyme disease borrelia spp.
The pathogenesis of tuberculous meningitis davis 2019 journal. Distinguishing between viral and bacterial meningitis is done using blood and csf cultures, as well as lumbar puncture opening pressure which reflects icp and csf analysis. Treatment for tbm should be initiated as soon as clinical suspicion is supported by initial csf studies. Childhood disease can be prevented by vaccination and by giving. The duration of illness before diagnosis is variable and relates in part to the presence or absence of other sites of involvement. The pathogenesis of tbm is incompletely understood and further understanding is required in order to develop effective vaccines, optimal antibiotic and host directed therapies. Using the published diagnostic criteria, 14 we defined 49.
Pdf the pathogenesis of tuberculous meningitis researchgate. Dissemination of tb to the brain results in the most severe form of extrapulmonary tb, tuberculous meningitis tbm, which represents a. Our attempt to examine once more the pathogenesis of tuberculous meningitis will serve some useful purpose. All three categories are encountered frequently in regions of the world where the incidence of tb is high and the prevalence of postprimary dissemination is common among. Tb is spread from person to person through the air. Intensified antituberculosis therapy in adults with. The most common symptoms are fever, headache, and neck stiffness. Despite this fact, all cases of tuberculous meningitis associated with hydrocephalus are not suitable for a shunt operation. Treatment with antibiotics and other drugs is usually effective against the infection. Most cases are people who traveled to the united states from other countries where. Tuberculous meningitis is very rare in the united states.
Tuberculous meningitis is caused by mycobacterium tuberculosis. Meningitis, tuberculous nord national organization for. In patients with suspected herpes simplex virus hsv infection, empiric antiviral therapy is started to prevent complications of hsv encephalitis. The pathology and pathogenesis of tuberculous encephalopathy. Tuberculosis tb remains a leading cause of death globally. Tbm is typically a subacute disease with symptoms that may persist for weeks before diagnosis. Meningitis is an acute inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges. Tuberculous meningitis tbm is the most serious extrapulmonary manifestation of tuberculosis with mortality rates up to 50% observed in the context of hiv1 coinfection. Tuberculous meningitis an overview sciencedirect topics. Tb that occurs in the tissue surrounding the brain or spinal cord is called tuberculous meningitis. Dissemination of tb to the brain results in the most severe form of extrapulmonary tb, tuberculous meningitis tbm, which represents a medical emergency associated with high rates of mortality. The prognosis of tuberculous meningitis tbm continues to be dismal with mortality rate ranging from 20 to 50%. Bacterial meningitis is very serious because its onset is rapid and the infection is associated with a significant risk of death. Tuberculous meningitis tbm causes death and disability, with especially high rates of poor outcomes in children and individuals with an hiv1 coinfection.
Other symptoms include confusion or altered consciousness, vomiting, and an inability to tolerate light or loud noises. The pathogenesis of tuberculous meningitis tbm is poorly understood, but contemporary molecular biology technologies have allowed for. Tuberculous meningitis tbm is a form of meningitis characterized by inflammation of the membranes meninges around the brain or spinal cord and caused by a specific bacterium known as mycobacterium tuberculosis. Cns tuberculosis manifests itself primarily as tuberculous meningitis tbm and less commonly as tubercular. They invade the meninges either by direct contact or through the perivascular lymph spaces 71%.
British infection society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children. Recent developments in tuberculous meningitis pathogenesis and. The dots in the air represent droplet nuclei containing tubercle bacilli. Tuberculous meningitis causes, symptoms, diagnosis. It can be treated with appropriate antibiotics that also prevents spread. Dissemination of tb to the brain results in the most severe form of. Cytokines do play a role in pathogenesis of tuberculous.
New murine model to study the pathogenesis of tuberculous. No guidelines exist as to the components and duration of treatment in the case of multidrug resistant tbm. Mycobacterium tuberculosis bacilli enter the host by droplet inhalation. The bacteria spread to the brain and spine from another place in the body, usually the lung. Diagnos tic and radiological features, pathogenesis and biomarkers 103 tion of the flow of cerebrospi nal fluid at the level of the tentorial opening, leading to hy.
Central nervous system tuberculosis is the most severe form of extrapulmonary tuberculosis disease. In 93 cases foci were located in the cerebral or spinal substance 46. The pathogenesis of tuberculous meningitis davis 2019. Central nervous system cns tuberculosis tb includes three clinical categories. Young children often exhibit only nonspecific symptoms, such as. Diagnostic and radiological features, pathogenesis and biomarkers with the diagnosis of tb meningitis. Tuberculous meningitis tbm is the most common form of central nervous system tuberculosis tb and has very high morbidity and mortality.
Pathogenesis and immune response in tuberculous meningitis article pdf available in malaysian journal of medical sciences 211. The lta4h genotype influenced the pretreatment intracerebral. The clinical features are fever for more than seven days, headache, and neck stiffness 1,6,1012. Intracranial tuberculomas developing while on therapy for pulmonary tuberculosis. Treatment includes four drugs, which were developed more than 30 years ago, and prevents death or disability in less than half of patients. Tb meningitis tuberculous meningitis can display symptoms such as aches and pains, loss of appetite and tiredness, with a persistent headache, there are around 150 200 cases of tb meningitis reported each year in the uk. Tuberculosis meningitis challenges and opportunities. Since the summer of 1952, we have been trying to reveal the pathogenesis of tuberculous meningitis chiefly by the findings of. A prospective study from a tertiary care center in india. Treatment for 12 months is probably a con servative. Cytokines do play a role in pathogenesis of tuberculous meningitis. In patients who are coinfected with hiv 1, tbm has a mortality approaching 50%. Tuberculous meningitis tbm is a condition ideally characterized as meningoencephalitis, as it not only affects the meninges but also the brain parenchyma as well as the vasculature. Symptoms include headache, decreased level of consciousness, and neck stiffness.