Extrapulmonary tuberculosis: tuberculous meningitis new developments

R. Galimi

From the Department of Neurology, Local Health Unit of Valtellina and Valchiavenna, Sondalo Hospital, Sondrio (Italy)

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• Neurology

Tuberculosis (TB) can involve any organ system in the body. Extrapulmonary involvement can occur in isolation or along with a pulmonary focus as in the case of patients with disseminated tuberculosis. Tuberculosis meningitis (TBM) is the most severe form of extrapulmonary tuberculosis. TBM a medical emergency, is still a major cause of serious illness in many parts of the world. TBM remains difficult to diagnose, and it is usually due to hematogenous dissemination of the tubercle bacillus. The exact incidence and prevalence are not known. The clinical spectrum is broad and may be non-specific making early diagnosis difficult. Improved outcome requires early recognition and treatment of these conditions. Clinical features included fever for more than 7 days, headache, or neck stiffness. While TBM is a disease of childhood, tuberculomas and spinal tuberculosis are invariably an adult manifestation. In HIV infection, TB is often atypical in presentation, frequently causing extrapulmonary disease, and patients have a high incidence of TBM. Clinical response to antituberculous therapy in all forms of neurotuberculosis is excellent if the diagnosis is made early before irreversible neurological deficit is established. Diagnosis is based on the characteristic clinical picture, neuroimaging abnormalities, cerebrospinal fluid changes and the response to anti-tuberculosis drugs. Diagnosis is best made with lumbar puncture and examination of the cerebrospinal fluid (CSF). Suspect TBM if there is a CSF leucocytosis (predominantly lymphocytes), the CSF protein is raised, and the CSF plasma glucose is
Corresponding Author: Rocco Galimi, MD; e-mail: glrocco@tiscalinet.it

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