Approach Tb and meningitis

When suspect Tb
– typical subacute

– Endemic or hx Tb or contact

– Fever cranial neuropathy

– Hydrocephalus w fever

– HIV or TNF HX

– CXR cavity w hypoNa

Phases at which phase

– constitutional 2-3 wk

– Meningeal = cranial n with

basal signs + long tract signs

– Encephalopathic phase

Which stage on GCS for severity

of dz to start empiric
– 1 alert

– 11 Confusion focality

– 111 Stuprous. Coma

Typical or Atypical
 – Acute rapid like bacterial
– Slow progressive memory
and dementia
– Encephalitic without
meningism
– Focal sign or seizure only
– Tuberculoma or.
Myeloradiculitis picture

Immuncompromised Or Not
– HIV

– DM alcohol

– TNF

– Transplanted

Complicated or not
– Hydrocephalus

– HypoNa

– Tboma

– Vision loss

– Vascular

Work up
Lab
– Routine

– Na

– CXR chest ct septum

 microbiology
– IGRA TST

Imaging. CT - MRI MRV contrast

CSF three samples

– analysis PMN or lympho
– Pressure

– AFB 60 Culture 50
– NAAT 80 ——-90 not

exclude
– Crypto Ag

– Typical or atypical csf

ADA adjunct if above 8

Imaging findings
– hydro

– Enhance

– Tboma

– Optic arachnoiditid

– Stroke

– Spinal

– Any other possibility

DDX
Brucellosis
Partial bacterial
Parameningeal
Encephalitis viral
Encephalomyelitis
Fungal vs toxoplasma
Neuoplastic vs lymphoma

Treatment giulines for TB

meningitis

IF Low resistance give 1st line

INH 10/kg
Rifa 20 /kg
Ethamb 20 /kg
Pyra 20 per kg
Strept 15 per kg

With steroid 6wks

‫ وٮ ﮴ﻜﻤﻞ او ل ﺛﻨٮ ﮵ﻦ‬.....‫ارٮ ﮳ﻌﻪ ﻟﻤﺪه ﺷﻬﺮ ٮ ﮵ﻦ‬

‫ﻟﻤﺪه ﺳﻨﻪ‬

IF resistant.... Do sensitivity test

– IF INH resistant give. 1st line

+ levo 10/kg.... For 1 yr

If INH resistant give the second

line 4 drugs - of the following

Levo
Amikacin
Ethionmid
Cyclosporin
Lenzo
‫ ﻟﻤﺪه ﺳﻨﻪ وٮ﮲ﺺ وﻻزم واﺣﺪ ﻣﻨﻬﻦ‬levo

IF MDR INH +Rifa resistant give

2nd line for 1.5 yr
- ‫ أﺷﻬﺮ ﮲ﺣﻤﺲ ادو ٮ ﮵ﻪ ﻻزم‬٨ ‫او ل‬
‫واﺣﺪ ﻣﻨﻬﻢ ﻟٮ ﮵﮲ڡﻮ‬
-‫ﻰ‬ ‫ ادو ٮ ﮵ﻪ واﺳﺤﺐ اﻟٮ ﮳ﺎڡ ﮴ ﮵‬٣ ‫وﻋﺸﺮ أﺷﻬﺮ‬

Indications of surgery in TB

- hyro
- TB oma
- abcess
- herniation
- compression vision tract
- cord tubercoloma
- failure for 2 months drug like on
abcess or tboma
Poor px.
Sever ، 14 day dz , focal , fit ,
coma
Age , miliary, block, low sugar ,
Abnormal cT , CD less 50

50% hi pressure
10% AFB
60% cultur
50% no CXR
10% miliary
Indications long steroid
Block
Edema
Sever meningitis
Arachnoiditis
Vasculitis

How to follow
– Clinical compliance

– CBC biochemistry for anti TB

– IRIS or paradoxically

– Tb oma

– Hydrocephalus

Screen the family

Paraneoplastic syndrom ‫ﺳﻮال ا‬

‫ﻰ ﮲ڡﺎٮ ﮵ﻨﻞ اورال‬
‫زﻛ ﮵‬
Encephalomyelitis MNDA. Caper
LGI
Beckerstaf stem .... ma Ta
Cerebellar
Rasmussin ophilea
Parkinsonism CRAmP
Para optic CRMP
retinopathy. Ring scotoma.
Recovrin
Hashimoto encephalitis
Myelopathy HU CRAMP Tr
Neuropathy. Cv2
LEMS. Hu. VGCC
Motor neuropathy. Hu. Tr
Neuronopathy. Hu
Mystthenia .... ach ab
Stiff person ... amphysin glycin
GAD
Issac Cramp
Opsoclonus myoclonus ......
neuroblastoma. Hu stomach
breast
Approach to. SAH