Management of tuberculosis meningitis

This article examines the detection, assessment, and therapeutic modalities available for tuberculosis meningitis. Without appropriate treatment this disease is fatal within 2 months of development, and mortality is closely associated with the stage of disease upon initiation of chemotherapy. Initial lumbar puncture reveals smear-positive acid-fast bacilli in up to 40% in most series; however, repeat examinations increase the yield, via direct smear, to as high as 87%. Analysis of cerebrospinal fluid is described, along with advanced techniques for early detection of this infection. Eight antituberculosis agents have known penetration into the cerebrospinal fluid. The most important prognostic factor is the neurological stage at which the individual presents at the initiation of therapy. Various chemotherapeutic approaches are available but it appears the use of rifampicin (rifampin) with isoniazid-containing regimens gives the best results. Regardless of the therapy undertaken, a significant number of individuals are left with some degree of neurological deficit. The roles of bacillus of Calmette and Guérin (BCG) vaccine, steroids, and neurosurgery in the treatment of this disease are also discussed.