Tuberculous meningitis - Revision history

Aidan at 15:47, 13 March 2023

2023-03-13T15:47:14Z

← Older revision		Revision as of 15:47, 13 March 2023
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	**Stage 3: 60%		**Stage 3: 60%
	*Morbidity is high, with about 20% of patient being left with significant neurological sequelae		*Morbidity is high, with about 20% of patient being left with significant neurological sequelae
	**Mental retardation, psychiatric disorders, ~~seizures~~, blindness, deafness, ophthalmoplegia, hemiparesis		**Mental retardation, psychiatric disorders, [[seizure]], blindness, deafness, ophthalmoplegia, hemiparesis

	==Differential Diagnosis==		==Differential Diagnosis==
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	*Rule out neoplasm and fungus, then start empiric treatment		*Rule out neoplasm and fungus, then start empiric treatment
	*HIV test (delay antiretrovirals by 8 weeks, though)		*[[HIV]] test (delay [[HIV medications\|antiretrovirals]] by 8 weeks, though)
	*Standard HREZ x2mo then HR x7-10mo		*Standard HREZ x2mo then HR x7-10mo
	**Can replace ethambutol with a fluoroquinolone		**Can replace [[ethambutol]] with a [[fluoroquinolone]]
	*Adjunctive steroids for high risk of IRIS		*Adjunctive steroids for high risk of IRIS
	**[[Dexamethasone]] 3mg po qid x2wk then taper over 6-8wks		**[[Dexamethasone]] 3mg po qid x2wk then taper over 6-8wks
	**Prednisolone 120 mg PO daily x1wk, 90 mg x1wk, 60 mg x1wk, 30 mg x1wk, 15 mg x1wk, 5 mg x1wk		**[[Prednisolone]] 120 mg PO daily x1wk, 90 mg x1wk, 60 mg x1wk, 30 mg x1wk, 15 mg x1wk, 5 mg x1wk

	{\| class="wikitable"		{\| class="wikitable"

Aidan at 15:29, 7 April 2022

2022-04-07T15:29:45Z

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 ==Differential Diagnosis==
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 *Standard HREZ x2mo then HR x7-10mo
 **Can replace ethambutol with a fluoroquinolone
-*Dexamethasone 3mg po qid x2wk then taper over 6-8wks
+**[[Dexamethasone]] 3mg po qid x2wk then taper over 6-8wks
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 |No data
 |}
 ==Further Reading==

Aidan: /* Differential Diagnosis */

2020-08-12T21:30:47Z

Differential Diagnosis

← Older revision		Revision as of 21:30, 12 August 2020
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	*Confusion, coma		*Confusion, coma

	=== Thwaites Index ===		===Thwaites Index===

	* Used to differentiate bacterial from tuberculous meningitis in adults before results of CSF culture are available[[CiteRef::thwaites2002di]]		*Used to differentiate bacterial from tuberculous meningitis in adults before results of CSF culture are available[[CiteRef::thwaites2002di]]
	* Tuberculous more likely if score ≤4; bacterial more likely if score ≥5		*Tuberculous more likely if score ≤4; bacterial more likely if score ≥5
	** Sensitivity 86% and specificity 79%		**Sensitivity 86% and specificity 79%

	{\| class="wikitable"		{\| class="wikitable"
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	\|}		\|}

	== Differential Diagnosis ==		==Differential Diagnosis==

	*[[Fungal meningitis]]		*[[Fungal meningitis]]
	*[[Sarcoidosis]]		*[[Sarcoidosis]]
	*[[Neoplasm]]		*[[Neoplasm]]
			*Other causes of [[chronic meningitis]]

	==Investigations==		==Investigations==
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	*CT head		*CT head

	== Diagnosis ==		==Diagnosis==

	* Gold standard is mycobacterial culture (71% sensitive, 100% specific)		*Gold standard is mycobacterial culture (71% sensitive, 100% specific)
	** Sensitivity increases with volume and number of samples		**Sensitivity increases with volume and number of samples
	* Microscopy for acid-fast bacilli is 20-80% sensitive and 100% specific		*Microscopy for acid-fast bacilli is 20-80% sensitive and 100% specific
	* PCR is 85-95% sensitive and 98% specific		*PCR is 85-95% sensitive and 98% specific
	** Used to confirm but not exclude the diagnosis		**Used to confirm but not exclude the diagnosis

	==Management==		==Management==

Aidan: /* Clinical Manifestations */

2020-08-12T21:19:34Z

Clinical Manifestations

Show changes

Aidan: Text replacement - "== Clinical Presentation" to "== Clinical Manifestations"

2020-08-02T13:08:26Z

Text replacement - "== Clinical Presentation" to "== Clinical Manifestations"

← Older revision		Revision as of 13:08, 2 August 2020
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	* Previous TB		* Previous TB

	== Clinical ~~Presentation~~ ==		== Clinical Manifestations ==
	=== History ===		=== History ===

Aidan: added Further Reading section

2020-06-05T22:09:55Z

added Further Reading section

← Older revision		Revision as of 22:09, 5 June 2020
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	** Ophthalmoplegia		** Ophthalmoplegia
	** Hemiparesis		** Hemiparesis

			==Further Reading==
			* Treatment of Tuberculous Meningitis and Its Complications in Adults. ''Curr Treat Options Neurol''. 2018;20(3):5. doi: [https://doi.org/10.1007/s11940-018-0490-9 10.1007/s11940-018-0490-9]

	[[Category:Tuberculosis]]		[[Category:Tuberculosis]]

Aidan: /* Management */

2020-06-05T22:08:14Z

Management

@@ Line 64: / Line 64: @@
 * Dexamethasone 3mg po qid x2wk then taper over 6-8wks
 ** High risk of IRIS
 == Prognosis ==

Aidan: /* Classification */ typo

2020-01-21T00:57:03Z

Classification: typo

← Older revision		Revision as of 00:57, 21 January 2020
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	=== Classification ===		=== Classification ===
	* '''Stage 1:''' normal level of consciousness, no focal neurological deficits		* '''Stage 1:''' normal level of consciousness, no focal neurological deficits
	* '''Stage 2:''' decreased level of ~~counsciousness~~, significant focal neurological deficits		* '''Stage 2:''' decreased level of consciousness, significant focal neurological deficits
	* '''Stage 3:''' seizures, comatose		* '''Stage 3:''' seizures, comatose

Aidan: /* Classification */

2020-01-21T00:55:20Z

Classification

← Older revision		Revision as of 00:55, 21 January 2020
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	== Background ==		== Background ==
	=== Classification ===		=== Classification ===
	* Stage 1: normal level of consciousness, no focal neurological deficits		* '''Stage 1:''' normal level of consciousness, no focal neurological deficits
	* Stage 2: decreased level of counsciousness, significant focal neurological deficits		* '''Stage 2:''' decreased level of counsciousness, significant focal neurological deficits
	* Stage 3: seizures, comatose		* '''Stage 3:''' seizures, comatose

	=== Epidemiology ===		=== Epidemiology ===

Aidan at 00:54, 21 January 2020

2020-01-21T00:54:54Z

← Older revision		Revision as of 00:54, 21 January 2020
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	* High mortality, often needs empiric treatment even before confirmed diagnosis		* High mortality, often needs empiric treatment even before confirmed diagnosis

	== ~~Classification~~ ==		== Background ==
			=== Classification ===

	* Stage 1: normal level of consciousness, no focal neurological deficits		* Stage 1: normal level of consciousness, no focal neurological deficits
	* Stage 2: decreased level of counsciousness, significant focal neurological deficits		* Stage 2: decreased level of counsciousness, significant focal neurological deficits
	* Stage 3: seizures, comatose		* Stage 3: seizures, comatose

	== Epidemiology ==		=== Epidemiology ===

	* About 1% of TB cases in Canada		* About 1% of TB cases in Canada

	== Differential Diagnosis ==		=== Differential Diagnosis ===

	* Fungal meningitis		* Fungal meningitis
	* Sarcoidosis		* Sarcoidosis
	* Neoplasm		* Neoplasm

	== Risk Factors ==		=== Risk Factors ===

	* Young		* Young
	* Female		* Female
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	* Previous TB		* Previous TB

	== Presentation ==		== Clinical Presentation ==

	=== History ===		=== History ===

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	=== Physical Exam ===		=== Physical Exam ===

	* Meningeal symptoms		* Meningeal symptoms
	* Fevers		* Fevers
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	== Investigations ==		== Investigations ==

	* Lumbar puncture		* Lumbar puncture
	** Increased lymphocytes, decreased glucose, and increased protein		** Increased lymphocytes, decreased glucose, and increased protein
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	== Management ==		== Management ==

	* Rule out neoplasm and fungus, then start empiric treatment		* Rule out neoplasm and fungus, then start empiric treatment
	* HIV test (delay antiretrovirals by 8 weeks, though)		* HIV test (delay antiretrovirals by 8 weeks, though)
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	== Prognosis ==		== Prognosis ==

	* Depends on stage at presentation		* Depends on stage at presentation
	* Mortality is high		* Mortality is high