Tuberculous meningitis. Difficulty of treating tuberculous meningitis

is an acute disease in which the membranes of the brain are affected by the tuberculosis bacillus and become inflamed. It is a complication of pulmonary tuberculosis. This article will describe the causes and mechanisms of its occurrence, the main symptoms, principles of diagnosis and treatment.

Causes and mechanisms of development

Tuberculous meningitis develops in people who already have pulmonary tuberculosis. The causative agent is Koch's tuberculosis bacillus.

Mycobacterium tuberculosis is an acid-fast bacterium. A person becomes infected with it through airborne droplets. The source of infection is a sick person. Nowadays, there is a significant increase in the incidence of tuberculosis. Doctors note that morbidity rates are approaching epidemic levels.

Bacteria enter the membranes of the brain through the bloodstream, hematogenously. First, they settle on the vessels of the brain, and then penetrate into its membranes, and cause acute inflammation there. There are groups of people whose risk of developing this disease is increased. These include:

• people who have tuberculosis or those who have already completed a course of therapy;
• people with immunodeficiency - HIV, AIDS;
• people who have a weakened immune system;
• people who have recently been in contact with patients with open tuberculosis.

Clinical picture

Unlike bacterial or viral inflammation of the membranes of the brain, tuberculous meningitis does not develop at lightning speed, but gradually. This form of meningitis is characterized by the presence of a pro-normal period of the disease, in which the following symptoms may be observed:

• The appearance of a headache. First, the headache hurts in the evening, or during sleep, and then it becomes almost constant. This headache is hardly relieved by painkillers.
• Weakness, apathy, increased drowsiness.
• Significant loss of appetite, up to anorexia.
• Irritability and excessive nervousness.

All these symptoms develop due to gradually increasing intracranial pressure. Since the inflammatory process develops gradually, meningeal syndrome begins to appear only 7-10 days after the start of the pronormal period. The main symptoms of meningeal syndrome are presented in the table:

Principles of disease diagnosis

Tuberculous meningitis - symptoms

First of all, the doctor examines the patient, collects anamnesis and medical history. Then he examines him and checks for meningeal symptoms. Already at this stage of diagnosis, the doctor suspects the development of meningitis. But to prescribe treatment and make an accurate diagnosis, laboratory and instrumental diagnostics are indispensable.

The main research method is lumbar puncture. With its help, cerebrospinal fluid and cerebrospinal fluid are collected for analysis. Main characteristics of cerebrospinal fluid in tuberculous meningitis:

1. Increased cerebrospinal fluid pressure during the puncture itself. With tuberculous meningitis, cerebrospinal fluid flows out in a stream or in frequent drops.
2. If you put the liquor in the light, on the windowsill, for example, after an hour a film will fall out of it, which will glow under the rays of the sun.
3. Increased number of cells in the cerebrospinal fluid. Normally, out of 3-5 in the field of view, and with tuberculous meningitis 200-600.
4. The protein level in the cerebrospinal fluid rises to 1.5-2 grams per liter. The norm is 0.1-0.2.
5. A decrease in glucose levels in the cerebrospinal fluid is observed only in patients who are not additionally infected with the HIV virus.
6. Koch's tuberculosis bacillus can be isolated in 10% of the liquor.

In addition to lumbar puncture, the following examinations are performed:

1. Plain radiography of the chest organs. It is needed to identify the primary tuberculosis focus.
2. General blood analysis. It is needed to assess the severity of the inflammatory process in the body, as well as to determine the blood cell composition. With a reduced color index, erythrocyte hemoglobin, the patient will have anemia.
3. Computed tomography of the brain is performed in acute forms of meningitis; it is needed to assess the volume of tissue affected by the inflammatory process.
4. Sputum microscopy is used to detect acid-fast tuberculosis bacteria in sputum.

Basic principles of treatment of tuberculous meningitis

Treatment of tuberculous meningitis is carried out in intensive care units at tuberculosis dispensaries. Therapy for tuberculous meningitis includes:

• Strict bed rest.
• Constant monitoring of blood pressure, heart rate, oxygen and carbon dioxide levels in the blood.
• Oxygen support is provided through a mask.
• Taking anti-tuberculosis drugs. The regimen for these medications is developed by the attending physician. The standard regimen includes Isoniazid, Rifampicin, Ethambutol, Pyrazinamide. Before prescribing these drugs, a sensitivity test is carried out. Recently, cases of resistance of tuberculosis bacteria to standard treatment regimens have become more frequent.
• Detoxification therapy. Includes intravenous administration to the patient of such solutions as Ringer's solution, Trisol, Disol, Reosorbilact, Polyglucin. These drugs are administered together with diuretics (Furosemide, Lasix) to prevent the development of cerebral edema.
• Hepatoprotectors – are prescribed to protect the liver from the hepatotoxic effects of anti-tuberculosis drugs. These include Heptral, Milk Thistle, Karsil.
• Corticosteroids are prescribed for infectious-toxic shock.

Complications of tuberculous meningitis

The course of tuberculous meningitis can be complicated by the following conditions:

• Brain swelling;
• Infectious-toxic shock;
• Encephalitis - involvement of the tissues of the brain itself in the inflammatory process;
• Sepsis;
• Partial paralysis or paresis;
• Herniation of the brain;
• Impaired hearing, vision, speech.

Tuberculous meningitis is a complication of primary meningitis. Unlike other types of inflammation of the meninges, the disease does not develop quickly, but gradually, over 1-2 weeks. Such patients are treated in tuberculosis clinics, in intensive care units, under the constant supervision of medical personnel.

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 forms, differing in symptoms and appropriate treatment:

1. 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.
2. 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.
3. 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 of age the disease begins in an acute form, the temperature rises sharply, vomiting, 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:

1. 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.
2. – 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.
3. Terminal period– the last stage of the disease, paralysis begins, heart rate increases, loss of consciousness, difficulty breathing, temperature up to 40 degrees. The last stage of 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, and the lungs and other organs are performed.

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 cerebrospinal fluid test results. 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 work activities unless they are determined to have 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 soaked in cold water on your head and limbs (arms and legs), changing them periodically as they warm 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.

Tuberculous meningitis is a dangerous infectious disease characterized by inflammation of the spinal cord and brain, developing against the background of a focus of tuberculosis (source of infection) in the body, which penetrates the membranes of the brain through the bloodstream, through the blood circulating throughout the human body, spreading the infection throughout all internal organs.

This disease requires special attention due to its complexity, dangerous aftereffects, including 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 elapses between the incubation period and the disease is 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, worsening after 2 or 3 turns of the head, in a supine position, as well as when straightening 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 tests can accurately establish the correct diagnosis, and only specialists can prescribe qualified treatment.

You should not self-medicate, as dangerous complications often arise in such cases; 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 the knee joint is extended, or the hip joint is bent.

Then, over the next 8-14 days, the symptoms intensify, the temperature increases to 38-39 ° C, pain appears in the frontal and occipital region, general weakness, photophobia occurs, loud sounds are poorly tolerated, drowsiness appears, constipation continues, and sudden onset is also possible. and the disappearance of red specks on the face and chest. 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 a special examination to confirm or refute the fact of its presence. The correct method is to study cerebrospinal fluid, which is taken with a special needle from the spinal cord in the area of ​​the lumbar 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 an open form of the disease through airborne droplets, or through standardized food products. Often it is not possible to determine the source of infection. In any case, it is always preceded by tuberculosis.

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 in the early stages, for this purpose, enterprises must provide mandatory medical examination where there have been cases of tuberculosis, both people, So animals, patients should be provided with individual housing with limited contact with healthy people, and 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 a hospital setting, and if the patient refuses hospitalization in the early stages of the disease, he is recommended to immediately consult with specialists: an infectious disease specialist and a neurologist.

Due to the specifics of the disease, treatment takes 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 medications are allowed:

1. For headaches - paracetamol 500 mg (no more than 1 g at a time, and 4 g per day);
2. For convulsions - benzodiazepines: diazepam 10 mg intravenously, together with 10 ml of 0.9% sodium chloride (it is worth knowing that rapid administration of this drug can cause respiratory arrest), rectal use is also allowed in a dose of 0.2-0.5 mg per kg (can be used for children);
3. 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;
4. 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;
5. 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 can prescribe the following medications: 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 required, which includes therapeutic physical exercise (under the supervision of a specialist), massage, sanatorium-resort recreation, preferably in specialized institutions for the 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 recovery, 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 exertion, overheating, and premature return to work is not allowed.

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, routes 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 diseases, 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.

An inflammatory disease of the membranes of the brain that occurs in the presence of a focus of tuberculosis in the body is called tuberculous meningitis. As a rule, it is secondary.

Forms

There are 3 clinical types of this disease:

Incubation period

This disease is divided into two stages:

1. The development of tuberculosis after the pathogen enters the body.
2. After the development of the underlying disease, the incubation period of meningitis ranges from 5 to 7 days.

Causes and risk groups

How is the disease transmitted? Tuberculosis can affect various parts and systems of the body. When mycobacteria of this disease penetrate the membranes of the brain, meningitis occurs.

Anamnesis, the severity of meningeal symptoms, tuberculin test indicators, the presence and timing of BCG vaccination and revaccination are studied. The final diagnosis is possible after analyzing the cerebrospinal fluid and examining the fundus, CT and MRI, radiography.

Liquor

The amount of cerebrospinal fluid in this disease is always increased by 4-6 times, globulin reactions are clearly positive, the percentage level of sugar is reduced, and the protein content is increased.

A special sign of tuberculous etiology is lymphocytic or lymphocytic-neutrophilic cytosis. There is a characteristic loss of fibrinous film after 12-24 hours, in which tuberculosis bacilli are found.

Read more about the collection of liquor in this article.

Microslide

In the choroid plexuses and in the substance of the brain, tuberculous tubercles are not always visible. Swelling of the brain, its edema, expansion of the ventricles of the brain, ventriculitis, ependymatitis, periarteritis, endarteritis are noted.

The latter is located in the form of couplings of lymphoid and epithelioid cells around the vessels, in which the formation of blood clots is possible. Insufficient therapy of PTP, as well as late diagnosis, lead to the development of fibroplastic processes.

Treatment of tuberculous meningitis

A phthisiatrician, together with a neurologist, diagnoses and prescribes a course of treatment for this disease. The optimal use of drugs isoniazid, rifampicin, pyrazinamide and ethambutol. If the use of the drugs gives the desired effect, after 2-3 months the dose of isoniazid is reduced, ethambutol and pyrazinamide are discontinued. Taking the drugs lasts at least 9 months. In parallel, the necessary treatment package is prescribed by a neurologist.

It includes:

• dehydration therapy – furosemide, acetazolamide, mannitol, hydrochlorothiazide;
• detoxification – infusions of dextran, saline solutions;
• glutamic acid;
• vitamins C, group B;
• in severe conditions – glucocorticoid therapy.

In the presence of paresis, neostigmine, ATP are added, and in the case of optic nerve atrophy - nicotinic acid, papaverine, heparin, pyrogenal. Bed rest lasts for about two months, by the end of the third month the patient is allowed to walk. Massage and exercise therapy are recommended no earlier than 4-5 months of illness.

Tuberculous meningitis is treated strictly under the supervision of specialists. There are no folk or alternative treatments; time wasted on them can aggravate the patient’s condition.

Rehabilitation

Patients with paresis and paralysis are prescribed massage and exercise therapy within 5 weeks after acute symptoms have resolved. To restore neuromuscular conduction, proserin is administered intramuscularly, and dibazol is administered orally. Physiotherapeutic appointments and vitamin therapy are also recommended.

After completing the full course of treatment, the patient is sent to a specialized sanatorium for 3 months or longer for follow-up treatment and rehabilitation. In the future, you may have to take anti-relapse courses, the timing of which depends on the doctor’s recommendations.

IMPORTANT! Monitoring and prescription of rehabilitation measures for tuberculous meningitis will be carried out by an anti-tuberculosis dispensary.

Complications

From the moment meningeal symptoms appear until the tenth day, it is important to diagnose the disease and begin active therapy. In this case, there are practically no unwanted complications.

If treatment is delayed, the main residual effects will be:

1. decreased clarity of vision;
2. convulsive seizures due to epileptic syndrome;
3. mental status disorders;
4. cognitive impairment;
5. paralysis and paresis;
6. blindness;
7. mental disability.

Prevention

Primary prevention of the disease includes.

Tuberculous meningitis is an inflammation of the soft membrane of the brain. In most cases, the disease is a complication of another form of tuberculosis. The category of people who have already suffered from this inflammatory process in any form is no exception. The disease is most often diagnosed in adults. The main risk group is people aged 40–70 years.

If treatment of the disease is not started in a timely manner, death cannot be ruled out.

Etiology

The etiology of this disease is well studied. The most common provoking factors for the development of the pathological process are the following:

• any localization;
• weakened immune system;
• severe infectious diseases;
• intoxication of the body;
• open brain injuries.

Due to certain etiological factors, the acid-resistant bacterium Mycobakterium enters the body. This serves as a prerequisite for the development of tuberculous meningitis. But it should be noted that the development of an inflammatory disease is more likely if a person has a severely weakened immune system.

Pathogenesis

Due to certain etiological factors, the provoking bacterium enters the body through the hematogenous route (with the blood). After this, the infectious organism settles on the soft membrane of the brain, where it begins to reproduce. At this stage, the human body tries to develop protection. A capsule is formed that temporarily localizes the infection. As the infection progresses, the capsule ruptures and infectious organisms enter the cerebrospinal fluid. Thus, tuberculous meningitis develops.

General symptoms

At the initial stages, tuberculous meningitis may not make itself felt at all, since the pathological process develops slowly. As this complication of tuberculosis develops, the symptoms become more pronounced.

A person affected by the infection may experience the following symptoms:

• apathy;
• drowsiness;
• weakness and malaise;
• increased body temperature;
• frequent headaches;
• changes in tone in the muscles of the neck and back of the head;
• nausea, occasionally vomiting.

In more severe cases, the patient may experience partial paralysis, which is associated with disturbances in the functioning of the nervous system and brain.

In addition to the above symptoms, some patients may be diagnosed with heart rhythm disturbances - or.

Stages of disease development

In official medicine, it is customary to distinguish the following stages of development of tuberculous meningitis:

• prodromal(feeling worse, headaches appear);
• excitement(symptoms of muscle stiffness, intense headaches appear, muscle pain, vomiting, and psychological disorders also begin);
• oppression(possible paralysis, coma).

Detection of the disease at an early stage of development practically eliminates the risk of serious complications, but subject to correct treatment. Therefore, at the first symptoms you should immediately consult a doctor.

Diagnostics

At the first signs, you should immediately consult a therapist. After a thorough personal examination and medical history, a comprehensive diagnosis is carried out.

Laboratory tests consist only of a general blood and urine test. If necessary, a biochemical blood test may be prescribed.

As for instrumental analyses, the following research methods are used:

• fluorography;
• test for tuberculosis (Mantoux);
• cerebrospinal fluid puncture;

Based on the results obtained, the doctor can make an accurate diagnosis and prescribe the correct treatment.

Treatment

Treatment of tuberculous meningitis is carried out only inpatiently. In the initial stages of tuberculous meningitis, patients may be prescribed the following drugs:

• isoniazid;
• rifampicin;
• pyrazinamide;
• streptomycin.

The dosage and frequency of administration are determined only by the attending physician. On average, the duration of therapy lasts about 6–12 months. But, the duration of treatment may vary depending on the general condition of the patient and the form of development of the disease.

In addition to special-purpose drugs, the patient is prescribed medications to strengthen the immune system. Also, during the period of treatment of tuberculous meningitis, the patient should eat well and in a timely manner.

It should be noted that tuberculous meningitis is a kind of last stage in the development of this pathological process. Therefore, all infectious and inflammatory diseases must be treated to the end so as not to cause such complications.

Treatment with folk remedies

Traditional medicine offers many remedies for the treatment of tuberculous meningitis. But, you can take any of them only as prescribed by your doctor.

The traditional method of treatment involves taking herbal decoctions from the following herbs:

• lungwort;
• marshmallow infusion;
• elecampane root;

From the above herbs you can prepare both decoctions and tinctures. But, they should be used on the recommendation of a doctor. Self-medication is not acceptable.

Prevention

Despite the fact that tuberculous meningitis is a dangerous disease, it can be prevented if simple preventive measures are applied in practice.

For children, an effective measure to prevent the disease is vaccination. This vaccination should be done at 7 and 14 years of age.

In addition, the following rules should be applied in practice:

• regular ventilation of the room and wet cleaning;
• compliance with personal hygiene rules;
• regular examination by a therapist;
• undergoing fluorography.

Such preventive measures make it possible, if not to completely avoid this disease, then to significantly reduce the risk of its formation. It is much easier to prevent any disease than to treat it later.

Self-medication with such a diagnosis is strictly contraindicated.

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