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Extrapulmonary Tuberculosis pp 101–120Cite as

Tuberculous Meningitis

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Abstract

Tuberculous meningitis (TBM) seems to be the most devastating form of tuberculosis caused by M. tuberculosis. The clinical picture of TBM is non-specific and may resemble the other causes of chronic meningoencephalitis. The sensitivity of cerebrospinal fluid examination is low and the growth of M. tuberculosis is slow in conventional culture systems. The nucleic acid amplification of CSF by PCR is highly specific and a negative result does not rule out the diagnosis because of its lower sensitivity. The neuroradiological features identified commonly in the course of the disease include basal meningeal enhancement, hydrocephalus, and infarctions. However, in the early period of the disease, 30% of patients have normal brain CT, and 15% of patients have normal brain MRI. In cases suspected of tuberculous meningitis, empirical anti-mycobacterial treatment should be initiated expeditiously. Although no randomized clinical trial showing the optimal combination of drugs and the duration of treatment exists, the treatment is administered for a year in which quadruple-drug regimen are administered for the first 2 months. It is recommended for multidrug-resistant tuberculosis that initial therapy consist of at least five active drugs (pyrazinamide and four second-line drugs) and injectable agents be administered for at least 8 months and total duration of treatment should be at least 18 months. The risk of tuberculosis is high in HIV-infected individuals. As early initiation of antiretroviral therapy in naive patients might lead to immune reconstitution inflammatory syndrome (IRIS), the antiretroviral therapy should not be initiated in the first 2 months. Using corticosteroids as adjuvant treatment prolongs the life-span. Despite all the efforts for diagnosis and treatment, neurological sequelae and mortality rates remain unacceptably high in TBM.

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Authors and Affiliations

  1. Fatih Sultan Mehmet Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey

    Derya Ozturk-Engin

  2. Carol Davila University of Medicine and Pharmacy; Dr Victor Babes Clinical Hospital of Infectious and Tropical Diseases, Bucharest, Romania

    Corneliu Petru Popescu

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  1. Derya Ozturk-Engin
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  1. Department of Infectious Disease & Clinical Microbiology, Onsekiz Mart University, Canakkale, Turkey

    Alper Sener

  2. ID-IRI Lead Coordinator, Department of Infectious Disease & Clinical Microbiology, Ankara, Turkey

    Hakan Erdem

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Ozturk-Engin, D., Popescu, C.P. (2019). Tuberculous Meningitis. In: Sener, A., Erdem, H. (eds) Extrapulmonary Tuberculosis. Springer, Cham. https://doi.org/10.1007/978-3-030-04744-3_8

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