Tuberculosis can affect not only the lungs. The causative agent of the disease (Koch's wand) penetrates into various 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 allows you to identify this ailment in the early stages. In this case, the disease can be cured. However, the tuberculosis 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
Tuberculous meningitis is an inflammation of the membranes of the brain. It is secondary in nature. All patients either suffer from active tuberculosis, or have suffered this disease in the past. It is sometimes very difficult to establish the primary focus of infection.
Outbreaks of tuberculous meningitis of the brain are most often observed in winter or spring. However, a person can get sick at any time of the year. This disease is especially susceptible to children, the elderly and patients with sharply reduced immunity.
The causative agent 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 primary lesion into the bloodstream. From there, it enters the brain, breaking 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.
- Together with cerebrospinal fluid, bacteria enter the base of the brain. There is an infection of the meninges, accompanied by their inflammation.
In this case, tubercles are formed 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 occur in the tissue of the organ, however, they are less pronounced than in the membrane. A gray mass appears at the base of the brain, resembling jelly in consistency.
Who is at risk
In addition to patients with tuberculosis, people at contact with the patient are also at risk. This pathology is often observed in people suffering from alcoholism and drug addiction. Bad habits extremely negatively affect the state of immunity. Tuberculous meningitis with HIV infection is quite common and is severe. Also, there is an increased risk of the disease in people who have suffered a head injury.
Disease classification
In medicine, it is customary to distinguish several forms of tuberculous meningitis, depending on the location of the lesion sites:
- Basilar meningitis. With this kind of disease, the lesion affects the cranial nerves. Signs of irritation of the meninges are pronounced, but there are no intellectual disorders. The disease is difficult, 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: limb paralysis and mental disorders.
- Serous meningitis. At the base of the brain, fluid accumulates (exudate). Signs of irritation of the meninges are not observed. This form is easy and usually ends in complete recovery. Complications and relapses are not noted.
Stages of the disease
In the clinic of tuberculous meningitis, several stages of the disease can be distinguished:
- prodromal;
- stage of irritation (meningeal syndrome);
- terminal.
Pathology is characterized 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. If untreated, the disease goes into the terminal stage. Patients have signs of encephalitis, paralysis, and the disease often ends in death. Next, we will examine in detail the symptoms and consequences of tuberculous meningitis at each stage.
Symptomatology
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. 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. Such a slow development of pathology is a characteristic feature of tuberculous meningitis.
Then comes the stage of irritation. The headache intensifies in the patient, it becomes painful and is localized in the forehead and occiput. The temperature rises sharply to 38-39 degrees. The patient becomes lethargic, lethargic 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, severe irritation of the receptors of the meninges occurs, which is called meningeal syndrome. Together with an intolerable headache, other specific symptoms of tuberculous meningitis also occur:
- Stiff neck. The patient sharply increases the tone of the neck muscles, because of this it becomes difficult for him to tilt his head.
- Symptom Kernig. The patient lies on his back. His leg is bent at the hip and knee. The patient cannot independently straighten the limb due to an increase in the tone of the muscles of the leg.
- Respiratory disorders The patient breathes heavily and intermittently. He has a feeling of lack of air.
- Fear of light and sounds. The patient constantly lies with his eyes closed, speaks little.
- Increased salivation and sweat.
- Horse Racing.
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. Strong tachycardia is noted, the pulse rate reaches 200 beats per minute. The patient falls into a coma. In the late stage of the disease, death occurs due to respiratory paralysis.
Features of the disease in children
Tuberculous meningitis is more common in children than in adults. Usually sick children under 5 years old or adolescents. The disease is accompanied by the same symptoms as in adults. However, in children, the negative consequences of pathology, such as hydrocephalus, are more often noted. 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, at the initial stage, swelling and tension of the fontanel occurs.
Complications
Tuberculous meningitis is dangerous because it can cause severe complications from the central nervous system. Most often, dropsy of the brain (hydrocephalus) is noted. This pathology occurs due to an adhesion process in the meninges.
Approximately 30% of patients after suffering an illness remain paralysis of the cranial nerves and paresis of the limbs. In more rare cases, there is a sharp deterioration in vision and hearing. Some patients have epileptic seizures.
Diagnostics
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 of tuberculous lesions of the meninges.
An important diagnostic test is spinal puncture. With tuberculous meningitis in the cerebrospinal fluid, the following pathological changes are noted:
- Increases cerebrospinal fluid pressure.
- High protein content is noted.
- The number of cellular elements is many times higher than normal.
- The presence of a Koch stick is detected.
- Sugar content is lowered.
It is also necessary to establish the localization of the primary focus of mycobacteria. For this, additional methods for diagnosing tuberculous meningitis are used:
- radiography of the lungs;
- fundus examination;
- examination of the lymph nodes, spleen and liver;
- a sample with tuberculin (Mantoux reaction).
To assess the neurological condition of the patient, 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 setting. Patients are prescribed combined treatment with several anti-TB drugs:
- "Streptomycin."
- "Isoniazid".
- "Rifampicin."
- Pyrazinamide.
- Ethambutol.
Assign 4-5 drugs at the same time in various combinations. This scheme is followed by the first 2-3 months. Then only two types of medication 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, the production of antidiuretic hormone is reduced in patients. This leads to cerebral edema. To stop this symptom, angiotensin receptor antagonists are prescribed: Loristu, Diovan, Teveten, Mikardis.
The patient must observe bed rest for 30 to 60 days. Only in the third month of illness, doctors allow a person to get up and walk. The patient is periodically given spinal punctures. Based on their results, the effectiveness of the prescribed treatment is evaluated.
In severe cases of hydrocephalus, surgical intervention is indicated - ventriculoperitoneal bypass surgery. 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 brain edema.
Forecast
The prognosis for life directly depends on the degree of pathology. If treatment is started in the early stages, then the disease is completely cured. Launched forms of pathology end fatally in 50% of cases.
About a third of patients after recovery have neurological consequences: paresis of limbs, paralysis of cranial nerves. They can be stored for 6 months.
With timely treatment, the patient may after some time return to his usual lifestyle. The disease in childhood can adversely affect mental development.
Dispensary observation
After discharge from the hospital, the patient must be registered with the TB dispensary for 2 to 3 years, regularly visit a doctor and take tests. During this time, he needs to take the drugs "Tubazid" and "Pask" according to a special scheme. A year after the course of therapy in the hospital, the question of the patient's further performance is being resolved.
If the patient has marked consequences of the disease, then he is recognized as incapable and in need of care. If the patient retains moderate residual effects, then he is considered unsuitable for work, but without the need for care.
If the patient has fully recovered and he 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.
Prevention
Prevention of the disease is to prevent infection with tuberculosis. People suffering from an active form of pathology are allocated a separate living area if they live in a dormitory or communal apartment. This is necessary in order to avoid infection of others.
The detection of tuberculosis in the early stages plays an important role in prevention. For this, tuberculin tests, fluorography are used. regular medical examinations. Infants in the first month of life must receive a BCG vaccine. This will help to avoid a dangerous disease and complications in the future.