TB Meningitis

HoPingKong-isms

1. “Give me a kernel of knowledge…” referring to Kernig's sign of meningitis – when the hip is bent at 90 degrees there is difficulty extending the knee secondary to pain (and resistance). This is usually coupled with Brudzinski's sign - a supine patient with meningism will flex at the hip and knee when their neck is passively flexed. These signs have very low sensitivity.

2. “Don’t be tense…” referring to tenosynovitis as one of the manifestations of disseminated gonococcal infection.

3. “I’m a megalomaniac today….” referring to megaloblastic anemias, as caused by B12 or Folate deficiencies.

Treatment of TB meningitis
For the first two months (the “intensive phase”) a number of antibiotics are used simultaneously – this is a slow growing organism and there is lots of resistance. Then the regimen can be altered based on the resistance pattern of the organism.

The drugs: INH, Rifampin, Pyrazinamide, and Ethambutol

Anything else I should add? yes, Steroids. Dexamethasone and Prednisone have both been used successfully – eg. 3 weeks of Dex (12 mg/day) then a 3 week taper (N Engl J Med 2004 Oct 21;351(17):1741-51.)


If the strain of TB is fully sensitive, you are now in the “Continuation phase” and treat with INH and Rifampin for 7 – 10 months. Go check out the Infectious Diseases Society of America web page for details (http://www.idsociety.org/)

That's all for now.