Tuberculosis meningitis

Question 1

CSF analysis

Answer 1

normal : WBC 0-5 cells/mm3, glucose 40-70 mg/dl, protein <40 mg/dl.
bacterial meningitis : WBC >1,000 cells/mm3, glucose <40 mg/dl, protein >250 mg/d.
tuberculous meningitis: wbc 100-500 cells/mm3, glucose <45 mg/dl, protein 100-500 mg/dl.
viral meningitis: wbc 10-500 cells/mm3, glucose 40-70 mg/dl, protein <150 mg/dl.
guillain-barre syndrome: wbc 0-5 cells/mm3, glucose 40-70 mg/dl, protein 45-1000 mg/dl.

Question 2

Tuberculous meningitis features?

Answer 2

subacute symptoms of meningitis irritation, nuchal rigidity, cranial nerve palsy (impaired adduction and lateral deviation of eye), CSF findings.

Question 3

TB meningitis risk factors?

Answer 3

occurs in 5% of of with extrapulmonary TB.
risk is increased in those with immunocompromise from alcoholism, substance abuse, malnutrition, immunomodulatory meds or HIV.

Question 4

TB meningitis presentation?

Answer 4

because mycobacterium tuberculosis replicates slowly, TB meningitis tends to present with weeks of pr0gressive headache, nausea/vomiting, fever, neck stiffness, and malaise. the inflammation can affect the basal portion of the brain, with pressure resulting from the dense gelatinous exudate often causing cranial nerve palsy.

Question 5

TB meningitis diagnosis?

Answer 5

imaging with contrast usually shows basal meningeal enhancement and small strokes ( from tuberculous vasculitis). non-contrast CT is sometimes normal. CSF findings show lymphocytosis with a leukocyte count of 100-500/mm3, mild protein elevation, low glucose, and elevated adenosine deaminase. acid-fast bacilli stain or nucleic acid amplification testing of CSF can provide rapid diagnosis, but culture is required for confirmation.