Tuberculous meningitis

Tuberculous meningitis is also known as TB meningitis or tubercular meningitis.

Tuberculous meningitis is a Mycobacterium tuberculosis infection of the meninges.

It is the most common form of CNS tuberculosis.

Li et al., collected lumbar and ventricular cerebrospinal fluid and serum from 40 children treated for tuberculous meningitis and measured the concentrations of gelatinases and their inhibitors. The concentrations of matrix metalloproteinase 9 (MMP-9), MMP-2, tissue inhibitor of metalloproteinase 1 (TIMP-1), and TIMP-2 were significantly elevated in the lumbar CSF samples, and we found interesting dynamics for MMP-9 that offer novel insight into its role in pediatric patients with tuberculous meningitis 1)

see Tuberculous meningitis hydrocephalus.

An HIV-positive mother infected her daughter with extensively drug-resistant Mycobacterium tuberculosis. Despite adhering to the then current guidelines for prevention, the infant was diagnosed with extensively drug-resistant pulmonary tuberculosis at the age of 4 months and developed tuberculous meningitis. After a short delay, appropriate treatment was initiated, followed by an inhospital stay at a specialised hospital. The infant became generally well, but had delayed neurological development. Secondary hydrocephalus due to tuberculous meningitis required a ventriculoperitoneal shunt. After 2 years of microbiologically and clinically effective tuberculosis treatment and several shunt complications, the HIV-negative child died at the age of 28 months ‒ with radiological signs of a shunt infection. The reason for the fatal outcome was probably related to inadequate risk reduction of airborne mother-to-child transmission, inappropriate chemoprophylaxis and delayed initiation of adequate treatment 2).

Li YJ, Wilkinson KA, Wilkinson RJ, Figaji AA, Rohlwink UK. Elevated Matrix Metalloproteinase Concentrations Offer Novel Insight Into Their Role in Pediatric Tuberculous Meningitis. J Pediatric Infect Dis Soc. 2019 Feb 12. doi: 10.1093/jpids/piy141. [Epub ahead of print] PubMed PMID: 30753686.
Gigi RMS, Rieder HL, Padayatchi N. When to start treatment? Dilemma illustrated by a paediatric case of extensively drug-resistant tuberculosis of the central nervous system. S Afr Med J. 2020;110(9):846-849. Published 2020 Aug 31. doi:10.7196/SAMJ.2020.v110i9.14567
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