Tuberculosis (TB) is a contagious airborne disease that typically affects the lungs. TB is caused by a bacterium called Mycobacterium tuberculosis. The bacterium can travel through the bloodstream if the TB infection is not treated quickly. It can infect other organs and tissues in the body.
Sometimes, the bacterium will travel to the membranes surrounding the brain and spinal cord (the meninges). Infection of the meninges can result in the development of a life-threatening condition known as meningeal tuberculosis. Meningeal tuberculosis is also known as tubercular meningitis or TB meningitis.
TB and TB meningitis can develop in children and adults of all ages. However, people with specific health problems are at greater risk for developing these conditions.
Risk factors for TB meningitis include having a history of:
- excessive alcohol use
- weakened immune system
- diabetes mellitus
TB meningitis is rarely found in the United States because of high vaccination rates. In low-income countries, children between birth and 4 years old are most likely to develop this condition.
Symptoms of TB meningitis typically appear slowly at first. They become more severe over a period of weeks. During the early stages of the infection, symptoms typically include:
- low-grade fever
As the disease progresses, the symptoms will become more serious. Classic symptoms of meningitis (e.g., stiff neck, headache, light sensitivity) are not always present. Instead, you may experience the following symptoms:
- changes in mental status (confusion)
- nausea and vomiting
Your doctor will perform a physical exam and ask you about your symptoms and medical history.
Your doctor may order additional tests if they think you have symptoms of TB meningitis. This may include a lumbar puncture (spinal tap). They’ll collect fluid from your spinal column and send it to a laboratory for analysis to confirm your condition.
Your doctor may order other tests to evaluate your health, such as:
- biopsy of the meninges
- blood culture
- chest X-ray
- CT scan of the head
- skin test for tuberculosis (PPD)
The complications of TB meningitis are significant, and in some cases life-threatening. They include:
- hearing loss
- increased pressure in the brain (intracranial pressure)
- brain damage
Increased pressure in the brain can cause permanent and irreversible brain damage. Call your doctor right away if you experience vision changes and headaches at the same time. This is a sign of increased pressure in the brain.
Your doctor may prescribe medications called anti-TB drugs, including:
These drugs will treat both the TB meningitis and TB infection.
Your doctor may also prescribe systemic steroids. Steroids will reduce complications associated with the condition. Depending on the severity of the infection, treatment may last as long as 12 months. In some cases, you may need to receive treatment in the hospital.
The best way to prevent TB meningitis is to prevent TB infections. In communities where TB is common, the Bacillus Calmette-Guérin (BCG) vaccine can help control the spread of the disease. This vaccine is effective for controlling TB infections in young children.
Treating people with non-active or dormant TB infections can also help control the spread of the disease. Non-active or dormant infections occur when a person tests positive for TB, but doesn’t have any symptoms of the disease. People with dormant infections are still capable of spreading the disease.
Your outlook will depend on the severity of your symptoms and how quickly you seek treatment. Getting an early diagnosis will enable your doctor to provide treatment. If treatment is received before complications develop, the outlook will be good.
Outlook for people that develop brain damage or stroke with TB meningitis is not as good. Developing increased intracranial pressure is a strong indication of a poor outlook for a person. Brain damage will be permanent and will impact health over the long term.
You can develop this infection more than once. Your doctor will need to monitor you after you’re treated for TB meningitis so they can detect the infection as early as possible.