TB can affect more than just the lungs. The causative agent of the disease (Koch's wand) penetrates into different systems of the human body. One of the most severe manifestations of this infection is tuberculous meningitis. In this disease, bacteria cause damage to the brain. Modern diagnostics makes it possible to detect this disease at an early stage. In this case, the disease can be cured. However, the tuberculous process in the central nervous system remains an extremely dangerous pathology. A neglected disease can lead to the death of the patient.
What is this disease
Tuberculosis meningitis is an inflammation of the lining of the brain. It is secondary. All patients either have active TB or have had the disease in the past. It is sometimes very difficult to establish the primary focus of infection.
Outbreaks of tuberculous meningitis of the brain most often occur in winter or spring. However, a person can get sick at any time of the year. Children, the elderly and patients with severely reduced immunity are especially susceptible to this disease.
Pathogen and pathogenesis of the disease
The causative agent of the disease is Koch's wand. It is also called Mycobacterium tuberculosis (MBT). This microorganism enters the brain in two stages:
- First, the bacterium enters the blood from the primary lesion. From there, it enters the brain, overcoming the barrier between the circulatory and central nervous systems. Koch's wand causes damage to the vessels of the lining of the brain. This leads to the appearance of granulomas in the organ.
- Bacteria enter the base of the brain along with the CSF. Infection of the meninges occurs, accompanied by their inflammation.
This causes tubercles to form in the brain. They are nodules or tubercles of microscopic size in the lesion. Inflammation affects not only the tissues of the membranes, but also the vessels. There is a narrowing of the cerebral arteries, which leads to a violation of local blood circulation. Pathological changes also occur in the tissue of the organ, but they are less pronounced than in the shell. A gray mass appears at the base of the brain, resembling jelly in consistency.
Who is at risk
In addition to patients with tuberculosis, the risk group also includes people who have been in contact with the patient. This pathology is often observed in people suffering from alcoholism.and drug addiction. Bad habits have an extremely negative effect on the state of immunity. Tuberculous meningitis in HIV infection is quite common and is severe. There is also an increased risk of the disease in people who have had a traumatic brain injury.
Disease classification
In medicine, it is customary to distinguish several forms of tuberculous meningitis, depending on the location of the lesions:
- Basilar meningitis. With this type of disease, the lesion affects the cranial nerves. Signs of irritation of the meninges are pronounced, but there are no intellectual impairments. The disease is severe, may recur, but with timely treatment ends in complete recovery.
- Cerebrospinal meningoencephalitis. This is the most severe form of tuberculous meningitis. It proceeds with damage not only to the membranes, but also to the substance of the brain. In 30% of cases, the pathology ends in death. After recovery, severe complications are often noted: paralysis of the limbs and mental disorders.
- Serous meningitis. Fluid (exudate) accumulates at the base of the brain. Signs of irritation of the membranes of the brain are not observed. This form proceeds easily and usually ends in complete recovery. Complications and relapses are not observed.
Stages of the disease
In the clinic of tuberculous meningitis, several stages of the disease can be distinguished:
- prodromal;
- irritation stage (meningeal syndrome);
- terminal.
Pathologycharacterized by gradual development. The prodromal stage can last up to 6-8 weeks. Then there are signs of irritation of the meninges, they are noted within 15-24 days. In the absence of treatment, the disease passes into the terminal stage. Patients develop signs of encephalitis, paralysis, and the disease is often fatal. Next, we will consider in detail the symptoms and consequences of tuberculous meningitis at each stage.
Symptomatics
The disease begins with a long prodromal period. At an early stage, the signs of the disease are nonspecific. Patients complain of headache in the evening, malaise, dizziness, nausea, loss of appetite. irritability. The body temperature may be slightly elevated, but there are cases of the onset of the disease without fever. There is a delay in urination and defecation. This slow development of pathology is a characteristic feature of tuberculous meningitis.
Then comes the irritation stage. The patient's headache intensifies, it becomes excruciating and is localized in the forehead and neck. The temperature rises sharply to 38-39 degrees. The patient becomes lethargic, apathetic and drowsy. His mind is confused. Red spots appear on the skin of the chest and on the face. which then quickly disappear.
At this stage, there is a strong irritation of the receptors of the meninges, which is called meningeal syndrome. Along with an unbearable headache, other specific symptoms of tuberculosis also occur.meningitis:
- Stiff neck. The patient has a sharp increase in the tone of the muscles of the neck, because of this it becomes difficult for him to tilt his head.
- Kernig's symptom. The patient lies on his back. His leg is bent at the hip and knee joint. The patient cannot straighten the limb on his own due to increased tone of the calf muscles.
- Respiratory disorders. The patient is breathing heavily and irregularly. He feels short of breath.
- Fear of light and sounds. The patient constantly lies with his eyes closed, talks little.
- Increased secretion of saliva and sweat.
- HELL jumps.
In the absence of therapy or insufficient treatment, the terminal stage of the disease occurs. Body temperature either rises to +41 degrees, or drops to +35. There is a strong tachycardia, the pulse rate reaches 200 beats per minute. The patient falls into a coma. At a late stage of the disease, death occurs due to respiratory paralysis.
Features of the disease in children
Tuberculosis meningitis is more common in children than in adults. Usually sick kids under the age of 5 years or teenagers. The disease is accompanied by the same symptoms as in adults. However, children are more likely to experience negative consequences of pathology, such as hydrocephalus. Sometimes the signs of the disease in the prodromal period resemble the clinical picture of acute poisoning. There is severe vomiting, weight loss, high fever. In infants, swelling and tension of the fontanel occurs already at the initial stage.
Complications
Tuberculosis meningitis is dangerous because it can cause severe complications from the central nervous system. The most common is dropsy of the brain (hydrocephalus). This pathology occurs due to the adhesive process in the meninges.
Approximately 30% of patients after suffering an illness remain paralysis of the cranial nerves and paresis of the extremities. In more rare cases, there is a sharp deterioration in vision and hearing. Some patients experience epileptic seizures.
Diagnosis
It is necessary to conduct a differential diagnosis of tuberculous meningitis with a bacterial and viral form of inflammation of the meninges, since the signs of these pathologies are similar. However, if the disease is caused by meningococcal bacteria or viruses, then it always begins acutely. A gradual onset is characteristic only for tuberculous lesions of the meninges.
An important diagnostic test is a lumbar puncture. With tuberculous meningitis, the following pathological changes are noted in the cerebrospinal fluid:
- Increases cerebrospinal fluid pressure.
- There is an increased protein content.
- The number of cellular elements is many times higher than the norm.
- The presence of Koch's wand is detected.
- Sugar reduced.
It is also necessary to establish the localization of the primary focus of mycobacteria. For this, additional methods for diagnosing tuberculous meningitis are used:
- radiographylungs;
- fundus examination;
- examination of lymph nodes, spleen and liver;
- tuberculin test (Mantoux test).
To assess the patient's neurological condition, CT and MRI of the brain are prescribed.
A TB doctor or neurologist makes a diagnosis based on a comprehensive examination.
Treatment methods
The intensive stage of treatment of this pathology is carried out only in a hospital. Patients are prescribed combined treatment with several anti-TB drugs:
- "Streptomycin".
- "Isoniazid".
- "Rifampicin".
- "Pyrazinamide".
- "Ethambutol".
4-5 drugs are prescribed simultaneously in various combinations. This scheme is followed for the first 2-3 months. Then only two types of medicine are left: Isoniazid and Rifampicin. The general course of treatment for the disease is quite long, it takes about 12-18 months.
To prevent the development of complications, glucocorticoid hormones are prescribed: Dexamethasone or Prednisolone. Also, to prevent neurological disorders, B vitamins, glutamic acid, "Papaverine" are administered.
During illness, patients have reduced production of antidiuretic hormone. This leads to swelling of the headbrain. To stop this symptom, angiotensin receptor antagonists are prescribed: Lorista, Diovan, Teveten, Micardis.
The patient needs to stay in bed for 30 to 60 days. Only in the third month of illness, doctors allow a person to get up and walk. The patient periodically makes spinal punctures. According to their results, the effectiveness of the prescribed treatment is evaluated.
In severe cases of hydrocephalus, surgery is indicated - ventriculoperitoneal shunting. During this operation, a catheter is inserted into the ventricle of the brain and excess fluid is removed. This helps reduce intracranial pressure and reduce cerebral edema.
Forecast
Prognosis for life directly depends on the degree of pathology. If treatment is started in the early stages, then the disease is completely cured. Advanced forms of pathology end in death in 50% of cases.
About a third of patients after recovery, neurological consequences remain: paresis of the limbs, paralysis of the cranial nerves. They can be stored for up to 6 months.
With timely treatment, the patient can return to his usual way of life after some time. A disease in childhood can negatively affect mental development.
Dispensary observation
After discharge from the hospital, the patient must be registered at the TB dispensary for 2-3 years, regularly visit a doctor and take tests. During this time, he needs to take drugs "Tubazid" and"Pask" according to a special scheme. A year after the course of therapy in the hospital, the issue of the patient's further working capacity is being decided.
If the patient has pronounced consequences of the disease, then he is recognized as disabled and in need of care. If the patient has moderate residual effects, then he is considered unfit for work, but without the need for care.
If the patient has fully recovered and does not have any consequences of the disease, then the person returns to his usual work. However, hard physical labor and exposure to cold are contraindicated for him.
Prevention
Prevention of the disease is to prevent infection with tuberculosis. People suffering from an active form of pathology are allocated a separate living space if they live in a hostel or communal apartment. This is necessary in order to avoid infecting others.
An important role in prevention is played by early detection of tuberculosis. For this, tuberculin tests, fluorography are used. regular medical checkups. Infants in the first month of life should be given the BCG vaccine. This will help to avoid a dangerous disease and complications in the future.
