Use of antibiotics is the first line of treatment for TB meningitis. To know about second line of treatment, read on…
Meningitis triggered by the tuberculosis bacteria is referred to as TB meningitis. In this condition, the meninges (membranes that form a cover over the brain and the spinal cord) get inflamed. The infection of the bacterium ‘Mycobacterium tuberculosis’ causes inflammation of the meninges, that can lead to severe brain damage if the treatment is delayed. This air-borne infection reaches the brain tissue from a specific body part, in most cases, the lungs. Thus, people affected with tuberculosis of the lungs may eventually suffer from TB meningitis.
TB meningitis is more common in children than adults. Even those diagnosed with HIV are at a high risk of developing TB meningitis. Living in unsanitary conditions, too much alcohol consumption and an impaired immune system are some of the factors that increase the chances of contracting TB meningitis.
Symptoms
Even after exposure to the bacteria, the person does not suffer from rapid onset of TB meningitis. TB meningitis advances gradually, making it difficult to diagnose in its initial stages. Meningitis signs that appear early such as fever, poor appetite, nausea, tiredness and aches are not diagnostic but seem to be obscure. It takes a while (weeks or even a year) before the actual symptoms become evident. Some of the specific symptoms that indicate the presence of TB meningitis are given below.
- Severe headache
- Stiff neck
- Confusion
- Seizures
Treatment
As bacteria are responsible for causing TB meningitis, treatment revolves around the use of antibiotics. The antibiotics chosen have the ability to reach the brain tissue and cerebrospinal fluid (a fluid that moves around freely over the surface of the brain and the spinal cord). These antibiotics are also referred to as anti-tubercular drugs as they treat meningitis triggered by tuberculosis bacteria. They are given below.
- Isoniazid
- Rifampicin
- Ethambutol
- Pyrazinamide
Unfortunately, in case of TB meningitis, treatment does not last for a month or two. The treatment lasts for a lengthy duration and so the fear of side effects looms large. A year’s time is the minimum duration for TB meningitis treatment. Aggressive treatment with these antibiotics is the need of the hour to improve the patient’s condition. A point to note that the treatment is given in phases. In the initial two months of treatment, the patient is put on isoniazid, rifampicin, pyrazinamide and ethambutol. In the next 10 months, doses of rifampicin and isoniazid are used to treat TB meningitis.
Second Line of Treatment
Second line treatment involves a change in the treatment plan when the first line of drugs prove to be ineffective. The doctor may use second line drugs, if the initial drugs fail to improve the patient’s health. Some of the drugs that may replace the aforementioned drugs are mentioned below.
- Seromycin
- Laniazid
- Nydrazid
Should steroids be used? Although data in the past (1950s) and even recent studies does indicate its benefits in managing symptoms, few studies do hint health complications associated with steroid administration. However, there have been instances that indicate the use of steroids like dexamethasone along with antitubercular drugs helps to speed up recovery and decrease the chances of death rate in children.
As per the treatment guidelines, patients with neurological problems and mental issues need to be given dexamethasone intravenously for around a month. Once this period is over, the patient is put on oral dexamethasone for 4 weeks. However, if the patient is mentally stable but is suffering from neurological disorders, the duration and dosage of dexamethasone dosage will change accordingly. On the whole, it is best to leave it to the doctor to decide whether steroid usage is necessary.
Administering BCG vaccines to small children can help to prevent TB meningitis. Infants in areas where there is widespread occurrence of TB meningitis, must be vaccinated. Immigrants that have traveled to places with high prevalence of TB should also be given BCG vaccination.
