Meningococcal tuberculosis. Tuberculous meningitis: causes and consequences
Tuberculous meningitis- this is dangerous infection, characterized by inflammation of the spinal cord and brain, developing against the background of a focus of tuberculosis in the body (source of infection), which penetrates the membranes of the brain through the bloodstream, through the blood circulating throughout the human body, spreading the infection to all internal organs.
This disease requires special attention, due to its complexity, dangerous aftereffects, even death, and also the fact that its harbinger is tuberculosis, which is quite easily transmitted, including by airborne droplets, especially with weakened immunity.
The level of damage to the human body depends on its individual characteristics. Weakened immunity, external factors, such as a constantly damp environment, are favorable conditions for infections that cause tuberculosis, etc.
The clinical picture of tuberculous meningitis depends on the manifestation of symptoms and signs of disease at various stages of its progression. The time that passes between incubation period and illness lasts less than 48 hours.
The disease is intense and characterized by rapid deterioration.
In the younger generation, signs of meningitis are much more common, pronounced, and no longer differ from adults.
Symptoms of tuberculous meningitis:
- feverish condition;
- headache, intensifying after 2 or 3 turns of the head, in a supine position, as well as when extending the knees of the legs bent at the hip joint;
- nausea, and as a result vomiting;
- loss of the ability to objectively perceive the environment;
- increased neck muscle tone;
- the appearance of small brown-red spots on the skin, mainly localized on the body and lower extremities;
- convulsions;
- fear of light;
- pale skin;
- there are constipation, problems with urination;
- an increase in body temperature, usually up to 38-39 degrees.
This, taken together, well characterizes the manifestations of tuberculous meningitis, but we should not forget that only laboratory research can accurately determine correct diagnosis, and only specialists can prescribe qualified treatment.
You should not self-medicate, as often in such cases there are dangerous complications, the following factors can serve as harbingers of death: decreased blood pressure, convulsions, impaired consciousness and speech, narrowing of intracranial arteries, drops in hemoglobin below 110 g/l, and old age.
For timely treatment, the diagnosis must be made within the first 10 days; after 15 days it is considered quite late, and can lead to serious consequences. In any case, you shouldn’t joke about your health; at the first signs, it is important to consult a doctor.
Symptoms of tuberculous meningitis tend to appear gradually, increasing rapidly over time. For example, the first 1-8 days the disease is characterized by the gradual onset of headache, dizziness, nausea, vomiting, and fever. Further, constipation may appear, problems with urine output, a rise in temperature to 37-37.5 0 C occurs, the tone in the neck muscles increases, the headache tends to increase when straightening knee joint, bent at the hip joint.
Then, over the next 8-14 days, the symptoms intensify, the temperature increases to 38-39 ° C, and pain syndrome in the frontal and occipital region, general weakness, photophobia occurs, loud sounds are poorly tolerated, drowsiness appears, constipation continues, and the sudden appearance and disappearance of red specks on the face and chest is also allowed. After 15-24 days complications arise.
But we should not forget that each person’s body has its own personal characteristics; some symptoms may be particularly pronounced, while others may not appear at all.
If signs of illness appear, you should seek the help of a specialist who will prescribe special examination to confirm or refute the fact of its existence. The correct method is to study cerebrospinal fluid, which is taken with a special needle from the spinal cord in the area lumbar region spine, diagnostic methods such as MRI of the head and tomography can be used.
Routes of transmission and prevention
It is important to know how the disease is transmitted, this occurs through infection with tuberculosis from a patient with open form diseases by airborne droplets, or through standardized food products.
It must be remembered that its occurrence is associated with living conditions, poor quality of social conditions, lack of proper nutrition, so that the body receives all the necessary microelements for its normal functioning. This weakens the immune system and creates favorable conditions for infection.
Such a disease is easier to prevent than to cure, we must remember the transmission routes of tuberculosis, in order to avoid infection with this disease, it is necessary to be able to promptly identify patients with early stages, for this purpose, enterprises must ensure mandatory medical examination where there have been cases of tuberculosis in both humans and animals, patients should be provided with individual housing with limited contact with healthy people, the organization of primary vaccination is no less necessary.
Males are more likely to suffer from this disease than women. It is typical for the age range from 20 to 39 years.
After treatment of tuberculous meningitis, a citizen must register with a dispensary for a period of 2-3 years, for the purpose of constant monitoring and to exclude recurrence of the disease.
Specifics of treatment
Due to the danger to human health of this disease, suspicion of tuberculous meningitis is an indication for immediate hospitalization, especially if more than 10 days have passed since the first symptoms appeared. The patient is transported in a supine position on a stretcher, and it is recommended that the head be slightly elevated.
Family members living with the patient should contact a specialist if they suspect similar symptoms.
Treatment of tuberculous meningitis is carried out only in inpatient conditions, and if the patient refuses hospitalization for early stages disease, he is recommended to immediately consult specialists: an infectious disease specialist and a neurologist.
Due to the specificity of the disease, treatment is carried out a long period, up to 12 months.
Neglecting proper treatment can cause complications that can subsequently cause death.
Folk remedies for treating tuberculous meningitis will not help.
It is necessary to limit the amount of drinking per day to 1 liter, and also reduce salt intake.
At the initial stage, the following may be used: medicines:
- For headaches - paracetamol 500 mg (no more than 1 g at a time, and 4 g per day);
- For seizures - benzodiazepines: diazepam 10 mg intravenously, together with 10 ml of 0.9% sodium chloride (it is worth knowing that rapid administration this drug, may cause respiratory arrest), also allowed rectal application at a dose of 0.2-0.5 mg per kg (can be used for children);
- With rapid development - antibiotics, 3rd generation cephalosporins: ceftriaxone intravenously 2 g (for babies 100 mg per kg per day), diluted in 10 ml of 0.9% saline solution;
- For infectious-toxic shock - 400 ml of 0.9% sodium chloride intravenously, prednisolone 60 mg in 10 ml of 0.9% sodium chloride, administration only slowly, ceftrixone 2 g intravenously. in 10 ml of 0.9% saline solution;
- For intracranial pressure - 15% mannitol 0.5-1.5 g/kg intravenously.
In the event of the development of tuberculous meningitis, urgent hospitalization is necessary; in addition, the administration of these drugs requires certain skills and abilities; it is important to remember that patients may be intolerant to any components of the drugs, and therefore they cannot be used.
A doctor in a hospital may prescribe the following: medicines: isoniazid, rifampicin, ethambutol, pyrazinamide. Antihypoxants, nootropics, diuretics and detoxification therapy (glucose, saline solution) are used.
After completing the course of treatment, a course of rehabilitation is necessary, which includes therapeutic physical exercise (under the supervision of a specialist), massage, sanatorium-resort recreation, preferably in specialized institutions prevention of tuberculosis.
Consequences of the disease
Tuberculous meningitis causes quite serious consequences, as a result of which the question arises about the patient’s ability to work. A person who has suffered from the disease can return to work or continue education only a year after recovery; in the first one to two months in the hospital, only bed rest is prescribed. After complete cure, the patient can return home, where he is registered with a dispensary and assigned 1 dispensary group.
For the first year, doctors visit the patient at his place of residence, and then he himself must come to the medical institution. If the patient does not come to the mark, then health workers should check him at his place of residence.
The environment must be appropriate to help the body recover, this means avoiding temperature changes, hypothermia, chronic diseases, heavy physical activity, overheating, not allowed premature return to work.
After a course of rehabilitation, a person can return to work, but preferably with a gentle regime, decent working conditions, and the absence of heavy physical activity.
Treatment, symptoms, modes of transmission, prevention - you need to know all this, be able to identify the signs of this disease in time, since it is one of the most serious illnesses, with a high probability of death or disability.
Adults need to take measures to protect children, themselves, and their loved ones from the threat of disease; for this purpose, it is necessary to vaccinate on time and maintain strong immunity.
Tuberculous meningitis is a secondary inflammation of the membranes of the spinal cord and brain in people with tuberculosis of various organs.
This disease, rare at present, mainly affects people from 40 to 65 years of age, as well as children under 5 years of age, although this rarely occurs, since children are required to be vaccinated against meningitis.
The causative agent of the disease is Mycobacterium tuberculosis. This form is especially difficult because the body was previously affected by tuberculosis - the immune system is weakened, there is no strength to fight the “scourge”.
How the infection is transmitted
The cause of tuberculous meningitis is infection from organs affected by tuberculosis: lungs, bones, genitals, breast, kidneys, larynx and others. Infection rarely occurs through contact.
In the presence of tuberculosis of the bones of the skull or spine, the infection can spread to the membranes of the brain. In approximately 17% of cases, infection occurs through the lymph.
Risk factors for developing the disease include:
- age– older people and children under 5 years of age have a weak immune system;
- seasonality– autumn and spring are the period of epidemics;
- other body infections, intoxication,.
It is necessary to distinguish between types of disease
Tuberculous meningitis has different shapes, characterized by symptoms and appropriate treatment:
- Basal– has cerebral meningeal symptoms in the form of the inability to pull the head to the chest due to hardening of the neck muscles, disruption of cranial innervation and tendon reflexes.
- Tuberculous– the most severe form of the disease, there are cerebral and meningeal symptoms (vomiting, paralysis of the limbs, etc.), as well as abnormal cranial innervation.
- Tuberculous leptopachymeningitis– develops extremely rarely; at the beginning of the disease there are almost no symptoms or they are barely noticeable.
If you detect one or more symptoms, having a provoking factor (tuberculosis of one of the organs), you must immediately seek help from a doctor. Tuberculous meningitis is dangerous due to its complications and adverse consequences.
Meningeal symptoms
Children at risk
More often, tuberculous meningitis develops in young children due to the lack of developed immunity or parental refusal 
vaccination against tuberculosis.
Mostly infants, weakened and premature children, as well as children from 3 to 5 years of age, are affected. Only in babies under one year old the disease begins in acute form, the temperature rises sharply, vomiting and convulsions begin, hydrocephalic syndrome and bulging of the large fontanel are noted.
In children older than one year, it usually begins with malaise, decreased appetite, and drowsiness. Then the temperature rises and vomiting begins - this happens within a week. Meningeal symptoms usually appear within 1-3 weeks.
Features of the clinical picture
Symptoms of tuberculous meningitis are divided into three stages:
- Prodromal period– lasts up to 6-8 weeks. Symptoms appear gradually: apathy, lethargy, drowsiness, weakness, and frequent headaches that gradually become stronger, the temperature rises to 38 degrees, nausea and vomiting begin.
- – signs of the disease intensify, the temperature rises, headaches in the back of the head, constipation, photophobia, intolerance to sounds, the appearance and disappearance of spots on the body. On the 6-7th day of this period, meningeal symptoms occur: stiff neck, Kernig and Brudzinski's sign, hearing loss, vision problems, speech impairment, decreased sensitivity of the limbs, hydrocephalus, increased sweating and salivation.
- Terminal period– the last stage of the disease, paralysis begins, heart rate increases, loss of consciousness, difficulty breathing, temperature up to 40 degrees. Last stage The disease ends in the death of a person.
In young children, the symptoms are similar to those in adults, only their development occurs in an acute form and the periods are shortened.
The main symptoms characteristic of tuberculous meningitis developing in children are: on the 2nd day, convulsions, vomiting, fever may begin, the child screams, the fontanel swells and pulsates.
In older children, the onset of the disease is gradual, and the manifestation of symptoms is blurred. Meningitis can be determined by the way the child lies; if he constantly lies on his side, with his legs tucked to his stomach and his head tilted back - this is a sure sign of the disease.
Goals and methods of diagnosis
Diagnosis of this disease within 10 days is considered timely, after 15 days - late. The disease is determined by three criteria: the presence of symptoms, identification of the source of infection and examination of the cerebrospinal fluid.
Tuberculosis infection can be in any organ of the patient, therefore:
- during examination, pay attention to the presence of tuberculosis of the lymph nodes;
- X-rays of the lungs are performed to detect tuberculosis;
- Enlarged liver and spleen are diagnosed;
- The fundus is examined.
Sampling of cerebrospinal fluid indicates tuberculous meningitis if the cerebrospinal fluid flows in a stream or in rapid drops. A complete examination for changes in the fluid indicates an accurate diagnosis.
In addition, blood is taken for general and biochemical analysis, carried out in the lungs and other organs.
Health care
Therapy lasts a very long time and is carried out only in a hospital setting. After treatment, which lasts up to a year, the patient is sent to a specialized sanatorium.
All treatment is aimed at destroying the tuberculosis bacillus and is carried out especially intensively for young children.
For example, if the drug Streptomycin can be administered intramuscularly to an adult patient, then this must be administered to a child into the spinal canal, because in infants the disease occurs in an acute form, and the slightest delay can cost life.
The goal of treatment of tuberculous meningitis is to eliminate the source of tuberculosis, treat inflammation of the meninges and eliminate it, prevent complications, relieve damage to the central nervous system, and relieve intoxication.
Conservative medicine
Treatment is carried out comprehensively using specialized drugs: Streptomycin, PAS, Ftivazid and Salyuzid.
Complex treatment prevents the emergence of resistant macobacterium tuberculosis and has a beneficial effect on relieving the inflammatory process, because all these drugs have an anti-inflammatory effect. The combination and dosage are prescribed by the doctor depending on the severity of the disease, tolerability of the drugs, and the patient’s condition.
At the same time, restorative therapy is prescribed: glucose systems, vitamins C, B1, B6, aloe. In case of complications, medications are prescribed to eliminate them.
Even with mild forms of the disease, the patient is discharged from the hospital only after six months, if the patient has good general condition and normal indicators cerebrospinal fluid tests. After discharge, treatment for tuberculosis and complications of meningitis continues.
Dispensary observation is carried out for 2-3 years. Immediately after the sanatorium, the patient is enrolled in group 1 of the local dispensary 
residence and then transferred to 2 and 3.
Children are observed by a phthisiatrician for a year in group A, then 2 years in group B, and the last 7 years in group C. If complications are noted, then observation by a neurologist, ophthalmologist, or psychiatrist continues. During the first 2-3 years, preventive courses are carried out for 3 months with Isoniazid in combination with Ethambutol.
Patients continue their labor activity, if they have not been identified as having a disability. Light work is required, mental stress is unacceptable for a year after treatment.
ethnoscience
Folk remedies in the treatment of tuberculous meningitis perform a supportive function and alleviate the suffering of the patient. But you can use them after consulting your doctor.
Herbal decoctions and tinctures are recommended: lungwort, marshmallow, elecampane root. You can put a pot of wisteria in the room where the patient is - the phytoncides it secretes disinfect the air and kill the tuberculosis bacillus.
At home, to alleviate the suffering of the patient, he should be provided with peace, both mental and physical, because he has heightened sensitivity to hearing, vision and touching the skin.
It is necessary to close the windows with curtains and isolate the patient from sounds and touches to the body. Place ice or rags dampened on the head and limbs (arms and legs). cold water, changing them periodically as they heat up. It is important to know that the patient should be hospitalized as quickly as possible in order to begin treatment immediately.
Is it dangerous?
The prognosis for treatment of tuberculous meningitis is favorable in 90% of cases if the diagnosis is made on time. If the diagnosis is made after 15 days of illness, the consequences can be the most dire. If the patient is immediately taken to the hospital, then complete recovery is possible even in small children.
A common complication is (paralysis of one side of the body), visual impairment, blindness. With the spinal form of meningitis, there may be paresis of the limbs and the development of pathologies of the pelvic organs.
For prevention purposes
The following preventive actions are distinguished to prevent infection with tuberculosis:
By taking precautions you can reduce the risk of infection. If it does happen, you should not self-medicate, but should urgently consult a doctor.
Meningitis is a disease that affects the pia mater of the brain.
Meningitis of tuberculous etiology occurs in any age group. The risk group consists of children with immature immune system and people with immunodeficiency states(AIDS, alcoholism, drug addiction).
Cause
The disease develops when the soft membrane of the brain is damaged by Mycobacterium tuberculosis. The basis of tuberculous meningitis is damage to the meninges by the tuberculosis bacillus. The source of tuberculosis bacillus (Koch bacillus) is primary lesions infections ( The lymph nodes, lungs, bones and other organs). From the source, the bacteria spread throughout the body, causing a disseminated form of tuberculosis. The infection enters the brain hematogenously, i.e. using blood vessels.
By hematogenous route, the bacteria reach the choroid plexuses of the ventricles of the brain, where they settle to form granulomas. From the choroid plexuses, the infection with a flow of cerebrospinal fluid reaches the base of the brain, where it affects. The histological picture of damage to the meninges has a specific manifestation. Tuberculosis bacillus, affecting the membranes of the brain, forms formations in the form of miliary tubercles (reminiscent of millet grain), especially a large accumulation of them at the base of the brain. Miliary tubercles cause perifocal (around the tubercles) inflammatory and allergic changes, which are aimed at limiting foci of infection and are clinically manifested. Inflammatory changes are accompanied by the appearance large quantity serous exudate (serous fluid), lead to clouding of the membranes and changes in vascular permeability. Changes to initial stages, and with adequate treatment from the first days, the disease can completely disappear. If treatment is not effective and started late, then inflammatory changes combined with tuberculous infiltration lead to organic changes in the meninges, brain matter and blood vessels. Appear adhesions, liquor dynamics are disrupted, which leads to the development.
Symptoms
The peculiarity of tuberculous meningitis is most often its gradual development. The first symptoms are nonspecific. A person may experience weakness, general malaise, drowsiness, daytime and insomnia at night, loss of appetite, apathy. May appear low-grade fever body (up to 37.5 C), especially in evening time. Gradually, a person begins to lose weight, in some cases vomiting appears, behavior changes, and interest in the world around him disappears.
As the disease progresses, headaches increase, insomnia intensifies, and nightmares appear. Memory and attention deteriorate sharply.
This period is called prodrome and lasts from 2 to 8 weeks. Then comes the height of the infection.
During the height of clinical picture consists of symptoms of damage to the meninges and symptoms of damage to certain areas of the brain, cranial nerves and may differ slightly in different patients.
Neurological examination reveals specific symptoms lesions of the meninges (stiff neck, Kernig's sign, Brudzinski's sign). Body temperature reaches febrile levels (38.5-39 C). In older people, there may be no increase in body temperature. The headache is intense, exhausts the person and does not bring him relief when changing body position. The listed symptoms add up to the clinical picture of meningeal syndrome.
IN childhood often appear, which represent a loss of consciousness and the occurrence of convulsions throughout the body. Any impact on a person (stroking, touching) causes discomfort. The cranial nerves are affected. When the 3rd, 4th, 6th pairs of cranial nerves (CNN) are involved in the process, strabismus and double vision appear. , hearing loss appears when the 8th pair of cranial nerves is damaged. A serious complication of meningitis is irreversible loss of vision with the development of atrophy optic nerves(2 pairs of cranial nerves).
If the clinical picture consists only of meningeal syndrome and/or damage to the cranial nerves, then they speak of the basilar form of tuberculous meningitis.
During the peak period, the blood supply to the brain is disrupted, which leads to the development focal symptoms: paresis (weakness) in the arms or legs, impaired understanding and reproduction of speech (), impaired sensitivity.
Tuberculous meningitis is inflammatory process in the membranes of the brain and spinal cord. It is not contagious, so contact with a sick person cannot provoke the development of pathology. The root cause of the disease is always active or previous tuberculosis.
Until recently, the disease was considered fatal, but currently in 15-25% of cases a person can be saved. However, a positive outcome is only possible if treatment is started immediately after the first symptoms appear.
How are other causes transmitted?
The causative agent of tuberculous meningitis is a pathogenic acid-resistant mycobacterium. It is characterized by virulence, that is, the ability to infect the body. The degree of damage in each case will be different, it all depends on the characteristics of the individual person’s body and external factors.
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The development of tuberculosis, which is the starting point for meningitis, is in most cases provoked by human or bovine pathogens. Mycobacterium M. Bovis is most often isolated in villages and villages, where it is transmitted through nutrition. People with immunodeficiency disease are also at risk of contracting avian tuberculosis.
Bovis and other representatives of the Mycobacterium species are prokaryotes: their cytoplasm does not contain highly organized organelles of the Golgi apparatus and lysosomes. On the other hand, mycobacteria also lack plasmids characteristic of some prokaryotes, which are responsible for the dynamics of the genome of microorganisms.
The shape of the mycobacterium resembles a straight or slightly curved rod with slightly rounded ends. Most of these microorganisms are thin and long with dimensions of 1-10 µm × 0.2-0.6 µm. However, the bullish species is always thicker and shorter.
Mycobacteria are immobile, do not form microspores and capsules, and their structure is as follows:
- microcapsule;
- cell wall;
- homogeneous bacterial cytoplasm;
- cytoplasmic membrane;
- nuclear substance.
The microcapsule is a wall of 3-4 layers with a thickness of 200-250 nm. It consists of polysaccharides and protects mycobacteria from environmental influences.
The microcapsule is securely attached to cell wall, which provides the microorganism with mechanical, osmotic and chemical protection. The cell wall contains lipids - it is their phosphatidic fraction that ensures the virulence of the entire Mycobacterium species.
The main carriers of the antigenic properties of mycobacteria are proteins, including tuberculin. Antibodies are detected by polysaccharides in the blood serum of tuberculosis patients. Lipids are responsible for the resistance of microorganisms to acids and alkalis.
Tuberculosis affects many organs in the human body: lungs, bones, kidneys, skin, intestines, lymph nodes. As a result, “cold” inflammation occurs, which most often has a granulomatous nature and provokes the appearance of a large number of tubercles that are prone to decay.
Course of the disease
The main source of mycobacteria entering the membranes of the brain is considered to be hematogenous. The entire pathological process develops over two stages.
First, sensitization of the body occurs. Mycobacteria break through the blood-brain barrier, infecting the choroid plexuses of the pia mater of the brain. After this, the microorganisms move into the cerebrospinal fluid, where they provoke the development of bacillary meningitis - a specific inflammation of the membranes at the base of the brain.
As mycobacteria move through the body, microscopic tubercles are formed in the tissues of the brain and in its meningeal membranes, which can also appear in the bones of the spine and skull. Another cause of tuberculosis can be miliary tuberculosis.
It is tubercles that cause the development of three pathological processes, which represent the clinical picture of tuberculous meningitis:
- inflammation of the meningeal membranes;
- formation of a gray jelly mass at the base of the brain;
- inflammation and narrowing of the arteries leading to the brain, followed by local brain damage.
As the disease progresses, not only meninges, but also the walls of cerebral vessels. Pathologists attribute these pathological changes to the results of hyperergic inflammation.
The brain parenchyma suffers less in tuberculous meningitis. Although foci of inflammation are found in the cortex, subcortex and trunk, they are usually localized only near the affected vessels.
Classification
In total, there are three types of tuberculous meningitis, which are characterized by the degree of prevalence and the specific location of the disease:
| Basilar |
|
| Cerebrospinal meningoencephalitis |
|
| Serous tuberculous meningitis |
|
With the meningeal form of the disease, the patient is likely to have a favorable outcome. Complications and relapses in such cases are extremely rare.
Symptoms of tuberculous meningitis
In young children, and especially in newborns, symptoms of tuberculous meningitis are much more common than in adults.
There are three periods of development of the disease:
- premonitory;
- irritation;
- terminal (paresis, irritation).
The prodromal period lasts from one to eight weeks, and is characterized by gradual development. The first signs are headache and dizziness. Then nausea appears, and less often, fever.
The patient complains of retention of stool and urination, elevated temperature bodies. However, science knows of cases where the disease proceeded without changes in temperature.
After 8-14 days, symptoms suddenly worsen. Body temperature rises sharply to a critical level of 38-39 degrees, pain appears in the forehead and back of the head. The patient feels drowsiness, weakness throughout the body, clouding of consciousness.
A little later, constipation appears without bloating, intolerance to light and noise, hyperesthesia skin. On the part of the vegetative-vascular system, persistent dermographism is observed. Red spots appear on the face and chest, which disappear as suddenly as they appear.
After a week from the onset of symptoms, patients experience mild meningeal syndrome, also known as Kernig and Brudzinski's sign, which is accompanied by headache, nausea and stiffness of the neck muscles.
When the content of serous exudate in the body is exceeded, irritation of the cranial nerves occurs at the base of the brain.
This condition is accompanied by a number of symptoms, including:
- vision problems;
- strabismus;
- eyelid paralysis;
- deafness;
- differently dilated pupils;
- swelling of the fundus.
In the presence of hydrocephalus, the severity of the disease does not matter: in all cases, the exudate blocks certain cerebrospinal connections to the brain, which can cause fainting. If such symptoms are observed regularly, they may portend an unfavorable outcome for patients.
If the exudate blocks spinal cord, the patient may experience not only weakness of the motor nerves, but also paralysis of both legs.
On days 15-24 of the disease, the terminal period begins, which is characterized by symptoms of encephalitis, including:
- loss of consciousness;
- tachycardia;
- Cheyne-Stokes breathing;
- extreme heat- 40 degrees;
- paraplegia;
- paresis.
The spinal form in the second and third periods is characterized by severe girdling pain, paralysis of both legs and bedsores.
Diagnostics
Ideally, the diagnosis of tuberculous meningitis should be made after ten days from the onset of symptoms. In this case, the chances of a favorable treatment outcome will be maximum. Diagnosis after 15 days is considered late.
The diagnosis of tuberculous meningitis is not easy to make.
An alarm signal should be the presence of all signs of the disease at once:
- prodrome;
- intoxication;
- constipation, difficulty urinating;
- navicular abdomen;
- symptoms of traumatic brain injury;
- a certain character of cerebrospinal fluid;
- clinical dynamics.
The location of tuberculosis infection in the body can be anywhere.
Therefore, when examining a patient, doctors pay attention to the presence of:
- tuberculosis of lymph nodes;
- X-ray results showing signs of tuberculosis;
- enlarged liver and/or spleen;
- choroidal tuberculosis.
The insidiousness of the disease is that even at a severe stage, the tuberculin test may turn out to be negative.
Fortunately, there are other signs that help recognize the disease during diagnosis:
- high pressure in the spinal cord;
- clear cerebrospinal fluid;
- formation of a fibrin network;
- increased protein content - 0.8-1.5-2.0 g/l with a norm of 0.15-
0.45 g/l. - low blood sugar.
Both and are characterized by a sudden and acute onset. Tuberculous meningitis in HIV-infected people progresses more slowly, but is no less severe. The only joyful fact is that mycobacteria are detected in only 1 out of 10 people.
A high probability of developing the disease is demonstrated by tuberculosis damage to organs or the presence of relatives who have suffered tuberculosis. At the same time, the most reliable way confirm or refute the diagnosis - get cerebrospinal fluid during spinal puncture.
Treatment
At the first suspicion of tuberculous meningitis, a person requires urgent hospitalization in a hospital. In a medical facility, doctors will be able to take x-rays, perform laboratory examination, perform a spinal function. An accurate diagnosis will help you choose the right treatment.
If tuberculous meningitis is left untreated, it can be fatal.
Treatment of complications
Most terrible diagnosis which a patient with tuberculosis can hear is “occlusive hydrocephalus.”
These require vigorous dehydration therapy:
- glucose injections;
- magnesium sulfate intramuscularly;
- massages;
- morning work-out;
- physiotherapy.
Specific methods of treating tuberculosis depend on the location of the lesion - pulmonary, bone or other. Serious surgical intervention possible only a year after final recovery and discharge from the hospital.
However, the treatment itself does not end there. After completing inpatient treatment, the patient is recommended to go to a sanatorium, where specific therapy will continue for 4-5 months.
Upon returning home, the patient should carry out specific therapy the next 18 months on your own. After completion of treatment, it is recommended to carry out antibacterial treatment for the next 2 years: in spring and autumn for 2-3 months.
Prevention
Basically, tuberculosis is common among socially disadvantaged sections of the population.
There are five main factors that provoke the development of the disease:
- poor socio-economic conditions;
- low standard of living;
- a large number of people without a fixed place of residence;
- high unemployment;
- increase in the number of illegal migrants.
According to statistics, men suffer from tuberculosis 3.3 times more often than women, and the incidence of infection does not depend on the region of residence. Citizens aged 20 to 39 years are more susceptible to the disease.
Another statistical fact: tuberculosis among prisoners in Russian correctional institutions is 42 times more common than the national average.
To prevent the disease, the following methods are used:
- preventive and anti-epidemic measures;
- identifying patients at early stages;
- allocation of funds for medicines;
- organization of mandatory medical examinations when hiring on farms where cases of bovine tuberculosis have been recorded;
- relocation to isolated living space of tuberculosis patients who live in communal apartments;
- organization of primary vaccination.
Dispensary observation
After hospital treatment for tuberculous meningitis, the patient should be observed by a doctor for another 2-3 years to eliminate the risk of relapse of the disease.
Since the consequences of tuberculous meningitis can be quite serious, the question of ability to work or continue education can be raised at least 1 year after discharge from the hospital. However, even after this time, patients are not recommended to return to physical labor. They are also contraindicated from sudden temperature changes.
During inpatient treatment, the patient is given strict bed rest for 1-2 months. After this, he is prescribed a more gentle regimen, during which he is allowed to eat sedentary meals, walk around the ward, and use the toilet. Then the patient is transferred to a training regimen, during which he goes to the dining room, walks around the territory of the medical facility and takes part in labor processes.
After complete recovery, the patient is transferred from the anti-tuberculosis dispensary to a medical institution at the place of residence, where the patient is assigned to 1 dispensary group.
When the patient does not visit the hospital for research, health care workers should monitor him regularly. For the first year after discharge, doctors should visit the patient at home.
It is important that the former patient is not influenced by factors that can provoke a relapse:
- hypothermia;
- excessive physical activity:
- overheating;
- premature return to work.
If present in the first year pronounced signs residual effects, a person is assigned disability group 1, he is considered disabled and needs constant care. If the condition is satisfactory, the person is recognized as professionally disabled, but not in need of care. A year after complete recovery, the former patient can return to work.
Despite the fact that tuberculous meningitis is a very serious disease, it can be treated with modern methods. Up to 80% of those cured successfully return to their profession or continue to study.
Tuberculous meningitis is an inflammation of the membranes of the brain, provoked by the entry and activation of tuberculosis bacteria. Develops as a secondary disease caused by progression or previous tuberculosis. Has a whole spectrum meningeal symptoms and extremely difficult to treat. The basis of therapy is anti-tuberculosis drugs, drugs for dehydration, and antibacterial therapy. At integrated approach in treatment has a favorable prognosis, but does not exclude the development of pathological complications.
In 90% of cases, tuberculous meningitis occurs as a result of the progression of tuberculosis, which is caused by a pathological decrease in immunity. The deterioration of natural protective properties is also due to the presence of other chronic diseases and infectious and inflammatory foci, autoimmune diseases, chronic alcoholism, HIV infection.
The source of tuberculous meningitis is:
- genital tuberculosis;
- kidney tuberculosis;
- pulmonary tuberculosis (95%);
- tuberculosis of bones and mammary gland.
It is extremely rare that infection occurs through airborne droplets. Meningitis develops due to the penetration of tuberculosis bacteria into the meninges, the number of which is rapidly growing and is not controlled by the immune system. Along with the blood flow pathogenic microflora can spread to all tissues and organs, contributing to the spread of infection throughout the body.
Pathogenesis
The causative agent of tuberculosis is able to pass through the blood-brain barriers and easily penetrate the meninges. Initially, small choroid plexuses of the soft membrane are affected, after which the infection penetrates into the cerebrospinal fluid, provoking the development of an extensive inflammatory process.
Next, the membranes at the base of the brain are affected, after which symptoms characteristic of meningitis appear. With absence drug therapy The deeper layers of the brain are gradually affected with further damage to the substance, which causes the development of meningoencephalitis.
The morphological signs of tuberculous meningitis are due to the presence of serous-fibrous inflammation, which is presented in the form of characteristic tubercles during diagnosis. Damage to blood vessels leads to their blockage and disruption of nutrition of parts of the brain. This in turn increases the risk of stroke and vascular infarction.
In childhood, tuberculous meningitis is characterized by the development of hydrocephalus, which is a life-threatening condition. Fluid retention and cerebrospinal fluid accumulation significantly increases intracranial pressure, which has a detrimental effect on brain nutrition. Irreversible processes develop that ultimately lead to death.
Classification of tuberculous meningitis
Considering clinical manifestations, tuberculous meningitis can be basilar, spinal and serous. Each type has its own characteristics.
Paralytic strabismus is a symptom of basilar tuberculous meningitis
Basilar
The onset of the disease occurs on days 3-5, after which the clinical picture changes gradually. The disease begins with typical signs of intoxication:
- high body temperature that does not go down;
- the appearance of nausea and vomiting “fountain”, especially after drinking liquid;
- acute pain in the head, which intensifies in the presence of light and sound stimuli;
- lack of appetite;
- constant drowsiness and desire to be in a horizontal position.
Meningeal symptoms develop when large nerves are damaged, which provokes:
- decreased vision and hearing, strabismus and pain when rotating the eyeball;
- severe pain in the back of the head and back of the neck, inability to tilt the head forward;
- facial asymmetry due to lesions facial nerve, responsible for the innervation of all parts of the face.
The terminal stage of the disease provokes the development of life-threatening symptoms that indicate severe damage to the cranial nerves. It becomes difficult for a person to breathe, all vital processes are disrupted. In the absence of treatment, it occurs state of shock with further death.
Cerebrospinal meningoencephalitis
Develops when tuberculosis pathogens spread into cerebrospinal fluid. In addition to the usual meningeal symptoms, atypical symptoms characteristic only of the cerebrospinal form of the disease appear:
- sharp pains along the entire spine;
- girdling pain that envelops the entire body;
- disturbance of reflex responses in the area of the spinal roots.
The pain is so severe that it cannot be relieved with blockades. Narcotic analgesics are not able to completely eliminate them, only easing the patient’s condition for a few hours. If left untreated, it leads to the development of infectious-toxic shock and death.
Serous tuberculous meningitis
The peculiarities of tuberculous meningitis of the serous form are that, against the background of damage to the membranes of the brain, an acute course of the disease develops, during the manifestation of which meningeal symptoms develop. Characterized by lightning-fast flow, but high chances of full recovery and minor risks of developing life-threatening complications.
General symptoms
The main difference between tuberculous meningitis and its other forms is that the prodromal (latent) period lasts up to 2 weeks, and clinical manifestations increase gradually. The patient periodically suffers from headaches (mainly in the evenings), decreased appetite and increased fatigue. Cephalgia intensifies and becomes permanent (like migraine), but painful sensations are within the tolerable range. Vomiting occurs periodically, not related to the digestive process.
During the period of activation of the disease, it develops sharp pain in the head, which is worse in bright light and loud sound. The temperature is rapidly rising, which cannot be brought down by anything.
Next, meningeal symptoms occur with characteristic stiffness of the neck muscles, profuse vomiting and paresis. The terminal stage provokes the appearance of extensive paresis and paralysis, disorders of the central nervous system And comatose state. Requires immediate resuscitation, as there is a high probability of death.
Diagnostics
Diagnosis of tuberculous meningitis in the initial stages of progression is inconclusive. The disease can only be detected when meningeal symptoms progress. The study includes a number of diagnostic procedures:
- Lumbar puncture - cerebrospinal fluid in tuberculous meningitis comes out under high pressure, characterized by increased turbidity and high content squirrel. Severe leukocytosis is diagnosed, as a result of which the causative agent of meningitis is identified. Meningoencephalitis differs from the basilar form in its high protein content and critical low performance glucose levels. Spinal tuberculous meningitis is characterized by a rich yellow color of the cerebrospinal fluid.
- MRI and CT - helps to identify localized lesions and also plays a key role in differential diagnosis.
Making a diagnosis is impossible without differential diagnosis, which eliminates the likelihood of developing diseases with similar manifestations:
- tick-borne encephalitis;
- pneumonia;
- dysentery;
- severe forms of influenza.
If there is a history of tuberculosis, diagnosis is carried out by a phthisiatrician under the supervision of neurologists.
Treatment
Treatment of tuberculous meningitis is carried out in a hospital setting. Antibacterial therapy is aimed at reducing the number of pathogenic microorganisms. In the spinal form, administration of the drug is indicated directly into the subarachnoid space, which increases the effectiveness of treatment.
Drug treatment
Treatment is carried out with Rifampicin, Ethambutol, Isoniazid. After cupping acute phase the dosage of the drug is reduced to a minimum. Drug treatment in the presence of tuberculous meningitis, it is carried out for at least 9 months.
Dehydration helps remove waste and toxins from the body, as well as replenish fluid levels in the body. To prevent the development of hydroencephaly, diuretics are prescribed.
Restore damaged neural connections and improve cerebral circulation Neuroleptics and nootropics help. Vitamin complexes with a predominance of B vitamins contribute to speedy rehabilitation.
Traditional methods
Alternative methods of medicine in the treatment of tuberculous meningitis are not used due to the danger of the disease and high risk development of death. As aid, which strengthens general immunity, can be prescribed herbal teas, which have an immunostimulating effect. Their use is possible only as prescribed by a doctor. Self-medication is prohibited, since the fight against tuberculosis bacteria can only be achieved with the help of properly selected antibiotics.
Possible complications
With the rapid progression of the disease and lack of adequate treatment, complications such as:
- decreased sensitivity of the skin of the extremities;
- paresis and paralysis;
- speech problems;
- decreased motor activity;
- decreased vision and hearing;
- epilepsy;
- psychomotor disorders.
An advanced form of tuberculosis can provoke death. With tuberculosis, there is a high probability of developing a relapse of meningitis.
Dispensary observation
The presence of tuberculosis dictates the need to register with a dispensary. There, doctors will monitor the patient's health status, performing preventive treatment and strengthening the body. It has been proven that patients registered with a tuberculosis clinic are less likely to experience meningitis than those who ignore doctor’s recommendations.
After suffering tuberculous meningitis, the patient must be under medical supervision for at least 1 year. This will help support the body and prevent the development of many complications.
Prevention
Since tuberculous meningitis is a consequence of tuberculosis, prevention involves preventing infection, which is possible with:
- routine BCG vaccine;
- reactions using tuberculin (mantoux);
- annual fluorography;
- maintaining immunity, which is possible with a balanced diet, an active lifestyle and the use of vitamin complexes.
To prevent the development of meningitis in the presence of tuberculosis, it is necessary to follow the doctor’s recommendations and mandatory be registered at a tuberculosis dispensary.
Forecast
In the absence of adequate treatment, rapid deterioration occurs general condition patient. The lethal outcome develops 25-30 days after the manifestation of the disease.
If treatment is prescribed in a timely manner, then in 95% of cases the prognosis is favorable. After 7-10 days, a rapid improvement in the patient’s health is observed, after which a period of rehabilitation begins.
To reduce the risk of relapse, treatment is carried out for at least 6-8 months, which helps control the course of tuberculosis.