What Is Tuberculous Meningitis?

Tuberculous meningitis is a severe form of bacterial meningitis caused by Mycobacterium tuberculosis, which also causes tuberculosis (TB).

The disease affects the central nervous system after starting elsewhere in the body. It is often characterized by inflamed membranes around the brain and spinal cord.

Symptoms begin with headaches and changes in the way you act. A fever, stiff neck, and vomiting may follow. More severe symptoms can make you feel confused or drowsy, leading to a coma. Without treatment, this disease can threaten your life.

Treatment involves taking antibiotics, often with corticosteroids. The best results occur when treatment begins early.

This article explains the symptoms, causes, diagnosis, and treatment of this disease.

Woman with headache

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Types of Meningitis

Meningitis is a disease that causes inflammation of the meninges, the membranes that cover your brain and spinal cord. The condition is often caused by a viral or bacterial infection. While rare, it can also occur as the result of other types of infections or even noninfectious causes like cancer, certain medications or a brain injury.

Tuberculous meningitis occurs when the bacterium that causes tuberculosis infects the tissue surrounding the brain or spinal cord. While it can affect anyone, the disease most often occurs in countries where there is a high incidence of pulmonary tuberculosis (infection of the lungs). According to the World Health Organization (WHO), tuberculosis is most prevalent in certain countries within Asia and Africa.

What Is Tuberculosis?

Tuberculosis is a contagious bacterial infection that is spread through the air when an infected person coughs, sneezes, or speaks. It usually affects the lungs, but can spread to the brain, spine, kidneys, and other parts of the body. Without treatment, tuberculosis can cause death.

Tuberculous meningitis and other forms of bacterial meningitis are often more serious than viral meningitis. Bacterial meningitis can pose a grave health threat because it can quickly lead to encephalitis, a swelling of the tissues around the brain. This prevents normal blood flow to and from the brain and can result in stroke, paralysis, or even death.

Symptoms

Early Symptoms

Early symptoms of tuberculous meningitis develop gradually. They can last from several days to months before illness presents.

Initial symptoms may be vague and not specific to meningitis, which can prevent a patient from seeking treatment. In the early stages of the disease, the following symptoms may occur:

In younger children, other symptoms can include:

  • Bulging fontanel (soft spot) in babies
  • Irritability or poor feeding in children
  • The head and neck arching backward, usually in infants less than 3 months old

In older children and adults, cognitive symptoms can begin with irritability and worsen to drowsiness and near-unconsciousness.

Advanced Symptoms

Without an accurate diagnosis and proper treatment, tuberculous meningitis can worsen to cause serious life-changing and life-threatening symptoms. At this stage, you may experience the following effects of the disease:

Causes

Tuberculous meningitis develops as a rare complication of tuberculosis, especially miliary tuberculosis. Miliary tuberculosis occurs when a large number of tiny spots form in the lungs. It develops in fewer than 2% of all cases of tuberculosis.

Miliary tuberculosis is so named because it causes spots the size of millet, which are the small round seeds found in bird food. The bacteria spread through the bloodstream, infecting other organs in the body. When the bacteria infect the brain and spinal cord, tuberculous meningitis occurs. This can be immediate or develop months or years after the initial infection.

The bacterium that causes tuberculosis is spread through the air when an infected person coughs, sneezes or talks. You have a higher risk of catching tuberculosis if you have a compromised immune system.

Diagnosis

The diagnosis of tuberculous meningitis is made by examination of your cerebrospinal fluid, the fluid that surrounds and protects your brain and spinal cord.

Cerebrospinal fluid is examined with a spinal tap, also called a lumbar puncture. This test removes a sample of cerebrospinal fluid. The sample is examined under a microscope to make the diagnosis. In some cases, more than one sample may be needed.

Other diagnostic tests, including a mycobacterial culture or a polymerase chain reaction (PCR) test may be used to confirm the presence of Mycobacterium tuberculosis.

Treatment

With a prompt diagnosis and medically supervised treatment and support, tuberculous meningitis can be cured.

Treatment of tuberculous meningitis should begin as soon as a diagnosis is confirmed. To prevent lost treatment time, your healthcare provider may advise you to start a treatment plan even before the results of your spinal tap are received (if they think you have the disease).

Treatment typically involves taking the following antibiotics for two months:

  • Hydra (isoniazid)
  • Rifadin (rifampicin)
  • Rifater (pyrazinamide)
  • Myambutol (ethambutol)

An additional 10 months of rifampicin and isoniazid are also required. Depending on your condition, your healthcare provider may also add a corticosteroid such as prednisone to your treatment regimen.

Prognosis

Delays in seeking medical care, diagnosis and the start of treatment contribute to the high morbidity (frequency at which a disease occurs in a population) and mortality rate (number of deaths) associated with tuberculous meningitis. It is the deadliest form of tuberculosis. The disease has the highest mortality rates in children and those with a coinfection of the more common type of human immunodeficiency virus (HIV-1).

Without treatment, tuberculous meningitis can be fatal. However, you can usually cure the disease if treatment starts early. The majority of patients fully recover by following their treatment plans and completing the course of medications advised by their healthcare provider.

Treatment for Close Contacts

If you have had close contact with a person with tuberculous meningitis or any form of meningitis, you may be eligible for prophylaxis treatment. This involves taking antibiotics to prevent the onset of the disease before it strikes. Contact your healthcare provider as soon as you learn you've been exposed to the disease.

Coping

Treatment for tuberculous meningitis can be frustrating because it typically lasts about a year. Long-term follow-up is needed to detect repeat infections.

If you experience complications like hearing loss, brain damage or learning disabilities as a result of tuberculous meningitis, you may have to learn to adapt to changes in your cognitive and/or physical abilities.

Summary

Tuberculous meningitis is the most severe form of illness caused by tuberculosis. It infects the membranes around the brain and spinal cord.

The disease causes swelling in these membranes, which hinders normal blood flow. This raises your risk of long-term cognitive and physical problems. Without treatment, the disease can be fatal.

Early symptoms, like fever and headaches, may be missed because they are common to many other ailments. This can cause a delay in diagnosis and treatment, which can increase your risk of long-term problems from the disease.

When symptoms point to the disease, a spinal tap is used to confirm a diagnosis. Early treatment with antibiotics gives you the best chance of curing the disease and recovering without problems.

A Word From Verywell

A diagnosis of tuberculous meningitis can be frightening. The disease is a serious condition that can cause life-threatening results without treatment.

You can help prevent the disease by getting vaccinated, following hygiene guidelines, and avoiding infected people.

If symptoms of tuberculous meningitis occur, seek medical treatment immediately. Symptoms can begin slowly, so it's important to be aware of subtle changes in your activity levels, appetite, and general wellness.

Getting an early diagnosis and treatment gives you the best chance of curing the disease without complications. Enduring treatment that involves taking medication for 10 months or longer can be challenging. However, following a medically supervised treatment plan can reduce your risk of long-term effects and improve your outcome.

Frequently Asked Questions

  • Is tuberculous meningitis curable?

    You have the best chance of curing tuberculous meningitis by getting an early diagnosis and starting treatment as soon as possible. Knowing your risk of getting the disease and recognizing symptoms early can improve your chances of a full recovery without complications.

  • Am I at risk for getting tuberculous meningitis?

    Tuberculous meningitis is relatively rare in the United States. When it occurs, it usually strikes children between the ages of one to five years. You also have a higher than normal risk of getting the disease if you have a weakened immune system, HIV, or have visited a country with a high incidence of tuberculosis.

  • How is tuberculous meningitis diagnosed?

    A spinal tap is the best way to diagnose tuberculous meningitis. The test involves extracting a sample of cerebrospinal fluid and examining it for the bacterium that causes the disease. A physical examination, PCR test and mycobacterial culture can also be used to support the diagnosis.

11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Anna Giorgi
Anna Zernone Giorgi is a writer who specializes in health and lifestyle topics. Her experience includes over 25 years of writing on health and wellness-related subjects for consumers and medical professionals, in addition to holding positions in healthcare communications.