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The most common type of tuberculosis (TB) which is prevalent in India is pulmonary TB i.e. the infection of the lungs due to the bacilli named Mycobacterium tuberculosis (MTB). But the same bacilli can spread to organs other than the lungs. Tuberculous meningitis (TBM) is one such extrapulmonary tuberculosis caused by seeding the MTB bacilli into the meninges i.e. the protective layer of tissues that covers the brain and spinal cord. Despite great advances in medical sciences and drug development, TBM remains a serious public health challenge, especially in developing countries like India.
MTB bacilli enter the body by the way of droplet inhalation, after which the infection establishes itself in the lungs, and then spreads to other organs in the body. But tuberculous meningitis can occur without a previously diagnosed pulmonary TB.
Symptoms of Tuberculous Meningitis
The commonly observed symptoms of tuberculous meningitis include fever, a stiff neck, headache and nausea/ vomiting. There may be confusion or trouble concentrating, sleepiness or waking, and sensitivity to light. Seizures or convulsions may occur as the disease progresses. Cranial nerve palsies, hemiparesis i.e. weakness in one half of the body and paraparesis i.e. weakness in both legs may occur in advanced cases. Due to the non-specific nature of early symptoms like fever and vomiting, patients usually delay seeking medical advice for many days or weeks. Also, due to lack of facilities, many times there is a delay in getting a proper diagnosis and initiating treatment. There have been instances where patients with fever and vomiting due to TBM are erroneously treated for appendicitis or other abdominal conditions, and present to Neurology services only after the disease worsens and causes complications like seizures.
Diagnosis and Treatment Procedures for Tuberculous Meningitis
Tuberculous meningitis is one of the most challenging causes of meningitis to diagnose because of the difficulty in identifying the MTB bacilli from The CSF. When the patient presents with symptoms suspicious of TBM like fever, headache, a stiff neck and nausea/ vomiting, the best neurologist in Baner, Pune may recommend testing after a detailed history and through physical examination. These tests include neuroimaging i.e. MRI of the brain/ spine to look for signs of infection and a lumbar puncture which is also called a spinal tap. It is performed to collect the cerebrospinal fluid from the spinal column that is sent for further analysis to the laboratory. Additional blood tests, Chest X-ray to look for evidence of pulmonary tuberculosis and tuberculin skin test may be advised.
The outcomes after treatment are directly related to the stage of the disease at the time of the diagnosis. If diagnosed early and treated promptly, tuberculous meningitis can be cured with medication administration and supportive care. If detected late during the illness, it is associated with higher death rates and permanent neurological disabilities, even after adequate management. Complications of TBM include seizures, stroke and paralysis and death.
Who is at Risk of Tuberculous Meningitis?
TB and TBM can affect children and adults of all ages. But people with certain health conditions are at a greater risk of developing this disease. Risk factors for developing TBM include:
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Patients with HIV/AIDS
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Immunocompromised individuals (Patients undergoing chemotherapy)
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Infants
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Diabetes mellitus
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Alcoholics
At Manipal Hospitals Baner, we have some of the best neurologists and medical technologies for diagnosing and treating Tuberculosis meningitis. If you observe any of the enlisted symptoms in yourself or your loved ones, visit best neurologist hospital in Pune and immediately consult a Neurology expert.
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