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TB Meningitis at The Workplace

02 November 2017   (0 Comments)
Posted by: Ernest Roper
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The following health related article is courtesy of the Association's health clinic. The Master Builders KwaZulu-Natal clinic and mobile clinic offering includes medicals and surveillance, health risk assessments, ear, eye, lungs or drug screening, HIV testing and counseling and First Aid training. For more information contact Elishya Abbu on 031 831 3209.

INTRODUCTION

TB meningitis is a life-threatening infectious disease that causes inflammation of the membranes that surround the brain and the spinal cord. These membranes are called the meninges and they help protect the brain from injury and infection. Tuberculous (TB) meningitis occurs when tuberculosis   bacteria (Mycobacterium tuberculosis) invade the membranes and fluid surrounding the brain and spinal cord.

The infection usually begins elsewhere in the body, usually in the lungs, and then travels through the bloodstream to the meninges where small abscesses (called microtubercles) are formed. When these abscesses burst, TB meningitis is the result.

 

RISK FACTORS

  • Upper respiratory tract infection.
  • Heamophilus influenza.
  • Otitis media and mastoiditis increase the risk of bacterial meningitis because it can cross the epithelial membranes and enter the subarachnoid space.
  • Immune compromised.
  • Pulmonary tubercolosis  it can be spread to other system/organs.
  • Excessive alcohol use.It can be transmitted through blood stream, direct spread such as traumatic injury to the facial bone or invasive procedures

CLINICAL MANIFESTATIONS

  • Photophobia and stiff neck.
  • Nausea and vomiting.
  • Severe headaches.
  • Seizures and confusion.
  • Fever and chills.
  • Agitation
  • Bulging fontanelles in babies
  • Decrease consciousness
  • Poor feeding or irritability in children
  • Unusual posture, with the head and neck arched backwards.

DIAGNOSIS

Diagnosis of TB meningitis can  be difficult and may be based only on clinical and prelimentary cerebrospinal fluid findings without definitive microbiological confirmation.

  • Lumber puncture is necessary, looking at biochemical markers (high protein and low glucose). Confirmed by acid bacilli stain and TB culture though this is often negative.
  • Biopsy of the brain or meninges.
  • Blood culture.
  • Chest x-rays.
  • CT scan of the head.
  • Gram stain, other special stains, and culture of celebro spinal fluid.
  • Skin test for tuberculosis.

TREATMENT

  • Isoniazid
  • Rifampicin
  • Pyrazinamide (PZA)
  • Ethambutol
  • Streptomycin
  • If severe, dexamethasone 0.4mg/kg/per day is given to reduce intra-cranial pressure.
  • Lasts up to 12 months.

PREVENTION

  • Vaccines such BCG to prevent severe forms of tuberculosis, such as meningitis.
  • Infection control precautions such as to wear aprons, masks, strict hand wash and disinfecting of hands in-between patients and isolate the patient for the first two weeks of treatment.
  • Antimicrobial chemo prophylaxis (INH) to all patients that are HIV positive and children less than 5years that are exposed to any form of TB.  

CONCLUSION

As we have seen TB meningitis it is difficult to diagnose due to non specific clinical manifestations, and the effectiveness of treatment takes long up to a year. The effectiveness of the treatment guidelines is determined by 2 major factors i.e. the cure rate and the level of acquired drug resistance. 

MASTER BUILDERS KWAZULU-NATAL OCCUPATIONAL HEALTH CLINIC


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