TB meningitis - Causes, Symptoms and Treatment .MF .
TB meningitis - is mostly secondary tuberculous lesion (inflammation) of the meninges (the soft, less firm and arachnoid), occurs in patients with different forms of tuberculosis of other organs.
Image inflamed brain (cut) in meningitis
reasons tuberculous meningitis
factors of disease risk are: age (reduced immune defense), season (usually fall ill in the spring and autumn), co-infections, intoxication, traumatic-mozgovaya injury.
tuberculous inflammation of the meninges occurs by direct penetration of mycobacteria in nervous system disorders due to vascular barrier.This occurs as a result of increased sensitivity of the cerebral blood vessels, membranes, choroid plexus, as a result of the above conditions.
Symptoms of tuberculous meningitis
Most disease begins slowly, but there are also cases of acute progressive (more children).
disease begins with malaise, headache, periodic increase in temperature (not exceeding 38), deterioration of mood in children.During the first week there is leth
then becomes intense headache, vomiting appears, marked irritability, anxiety, weight loss, constipation.There are a facial paresis, oculomotor and abducens.
Characteristic: bradycardia (slow heart rate - less than 60 beats per minute), arrhythmia (heart rhythm disturbances), photophobia.
There are changes in the eye: optic neuritis (inflammation) of the optic nerves, tubercles, which sees phthisiatrician).
2 weeks if treatment is not started, the temperature rises to 40, the headache persists, there is a forced posture blackout.Have a seat: paralysis, paresis (violation of motor activity of the limbs, face), cramps, dry skin, tachycardia (increased heart rate - more than 80 per minute), cachexia (weight loss).
After 3-5 weeks without treatment, death occurs as a result of paralysis of the respiratory and vasomotor centers.
the most common form of tuberculous meningitis is - basal tuberculous meningitis .This form is characterized by pronounced brain meningeal symptoms (clinical signs of meningeal irritation, occurs as a stiff neck - not the ability to bring your chin to your chest, and other neurologic symptoms), a violation of cranio - cerebral innervation and tendon reflexes (muscle contraction in response to the rapid expansion ormechanical irritation of the tendon, for example, if you hit him a neurological hammer).
The most severe form is tuberculous meningoencephalitis .Observed brain (vomiting, confusion, headache) and meningeal signs, focal (depending on the defeat of a division of the brain, such as unsteady gait, paralysis of limbs, etc.), as well as disorders of traumatic brain innervationhydrocephalus.
Rare tuberculosis leptopahimeningit .Characteristically gradual oligosymptomatic beginning.
If you have the above symptoms you need urgent hospital treatment.Timing depends on the form of the process of gravity.Treatment can last up to half a year or more.
tests in suspected tuberculous meningitis
The general analysis of blood marked increase in erythrocyte sedimentation rate, leukocytosis, lymphopenia, leukocyte formula shift to the left.
main method of diagnosis of tuberculous meningitis is the study of cerebrospinal fluid after lumbar puncture.Increased the number of cells (pleocytosis), dominated by lymphocytes.Also elevated levels of the protein, the composition changes to increase globulins.Positive reaction Pandey and Nonne-Appelt.When biochemical study revealed lowering glucose levels.Cerebrospinal fluid is colorless, transparent, opalescent may, in more severe cases - yellowish, formed upon standing tender fibrin film in a test tube.
Spend crop on Mycobacterium tuberculosis, in this type of research are detected in 15% of cases.As PCR is carried out - to 26% of cases are detected.ELISA method can not detect antibodies to Mycobacterium tuberculosis.
recently used computer brain tomography and magnetic resonance.Also in the complex is necessary to examine the light (X-ray, CT, MRI) and other bodies, to eliminate comorbidity.TB meningitis is rarely detected as the only defeat tuberculosis.Currently dominated by mixed infection: tuberculosis and fungi, tuberculosis, herpes, etc.
disease differentiate meningitis from a different nature.
Treatment of tuberculous meningitis
treatment is carried out only stationary, in the event of the above symptoms the patient is hospitalized.Treatment Duration: one year and more.
main drugs: isoniazid, rifampicin, ethambutol, pyrazinamide.Treatment is carried out according to the same pattern as any form of tuberculosis.
Symptomatic treatment: antioxidants, antihypoxants, nootropics - cinnarizine, nootropil (improves brain blood flow).Assign a diuretic (diakarb, Lasix) - prevention of cerebral edema.Detoxification therapy (glucose, saline).
Nutrition for tuberculous meningitis
high-protein diet is necessary: meat, fish, dairy products, milk.Limit fluid intake up to a liter per day.Limit the amount of salt.
Treatment folk remedies
When this pathology is better to restrict the treating physician not to have any serious, incurable consequences.
Rehabilitation after treatment
Rehabilitation depends on the severity of the process.It includes physical therapy, restorative massage, perhaps a spa treatment.
Complications of tuberculous meningitis
may experience complications such as: block the outflow of cerebrospinal fluid, hydrocephalus (a disease characterized by an accumulation of cerebrospinal fluid in the ventricles of the brain), hemiparesis (paralysis of the muscles of one side of the body), impaired vision, rarely to its full loss.At spinal form possible paresis of the extremities, pelvic disorders.
With timely treatment for medical assistance, treating many patients have a full recovery.Death in 1% of cases with late-treatment and treatment, especially in the form of meningoencephalitis.
prevention of tuberculous meningitis
In children, the disease can occur after contact with bacterial excretion (less often in adults).As well, the children are not vaccinated with BCG, or in the absence of post-vaccination hem, did not receive chemoprophylaxis after detecting a bend tuberculin reaction, especially in the presence of concomitant diseases.
and general recommendations: to avoid hypothermia, prolonged sun exposure, comply with treatment of chronic diseases.
doctor phthisiatrician Kuleshov LA