tuberculous meningitis

Introduction

see meningitis

Etiology

• meningitis due to tuberculosis

Clinical manifestations

• basilar meningitis
• cranial neuropathy
• mental status change
• SIADH

Laboratory

• cerebrospinal fluid
  • WBC < 300/mm3, predominantly lymphocytes
  • CSF protein 100-300 mg/dL
  • CSF glucose < 40 mg/dL or may be normal
• Mycobacterium tuberculosis DNA in CSF

Differential diagnosis

• listeriosis
• fungal meningitis

Management

• empiric coverage for bacterial meningitis including listeriosis until diagnosis of tuberculous meningitis confirmed
  • ceftriaxone, vancomycin, ampicillin
• isoniazid
  • 15-20 mg/kg/day (max 500 mg/day) in children
  • 8-10 mg/kg/day (max 300 mg/day) in adults c)] QD or BID
• rifampin
  • 15-20 mg/kg/day (max 600 mg/day)
  • QD or BID
• 6-9 months of therapy; 1 year of therapy MKSAP
• dexamethasone for 4-6 weeks may be of benefit

More general terms

• bacterial meningitis
• tuberculosis