Tuberculous MeningitisThis condition occurs most commonly shortly after a primary infection in childhood or as a part of miliary tuberculous.
Clinical features of Tuberculous meningitis:
|Headache,Lassitude.Anorexia,constipation. Loss of interest in toys.Unwillingness to talk. Low grade fever.||Headache,malaise.Vomiting.Low-grase fever,Confusion Depression.|
|Signs:||Meningism,Oculomotor palsies,Papilloedema,Depreddion of coscious level,Focal hemisphere signs.|
|2.||Culture of CSF on appropriate media.|
Table:CSF findings in different meningitis.
|Cell count/cmm||Lymphocytes 50-2000|
Treatment/Management:Treatment must be started without waiting for confirmation(culture report).
|1.||Anti-tuberculous chemotherapy:the principle is longer duration of treatment i.e. one year reginen|
|A)||INH 600mg daily orally for one year plus.|
|B)||Rifampicin 450-600mg daily orally for one year plus.|
|C)||Pyrazinamide 1500mg daily orally 3 month.|
|Pyridoxine 50mg daily orally for one year.|
|2.||Prednisolone 40mg orally for 4-6 weeks then taper gradually in another 4-6 weeks.|
|4.||Maintain adequate hydration and nutrition.|
|5.||Ventriculoperitoneal shunt must be adopted of obstructive hydrocephalus develops.|
|Note:||Intensive regimen of drug treatment should be continued for 8 weeks and followed by a contribution phase.|
|Reference:Davidson's Pricciples and practice of medicine 21st edition,page:1206-1209. Kumar and clark,clinical medicine,7th edition,page:1153-1156|