Rifampicin in tuberculous meningitis: a retrospective assessment

Treatment of tuberculous meningitis in adults with a combination of isoniazid, rifampicin and streptomycin: a prospective study

15 patients with tuberculous meningitis were treated with isoniazid, streptomycin and rifampicin and 14 with isoniazid, streptomycin and ethambutol for 12 months. Both groups received prednisolone at the beginning of treatment. The two groups were compared with regard to clinical improvement, presence of neurological sequelae and mortality. No difference in recovery rate between the groups was observed. 6 patients (21%) died (5 in group I and 1 in group II). Residual sequelae developed in 9 cases (5 in group I and 4 in group II; 31%). The difference between the groups was not significant. The regimen including rifampicin for tuberculous meningitis did not result in any superiority compared to standard therapy.

Tuberculous meningitis: a retrospective survey of 22 cases

Clinical and biological findings likely to constitute prognostic factors were analyzed in a retrospective survey of 22 cases of tuberculous meningitis. In particular, associations between clinical and biological findings (clinical grade on admission, normal and abnormal CSF protein and glucose values) and outcome of illness were sought. On admission 16 patients had altered consciousness, 11 hemiparesis and 7 sixth cranial nerve paresis. Meningeal signs were present in all subjects. 7 had a positive culture for Mycobacterium tuberculosis. 9 patients recovered completely, 7 had serious late sequelae, 6 died. Prognosis appeared to be correlated to neurological status at admission.

CNS tuberculosis

Tuberculous meningitis is a rare, treatable neurologic disorder, in which early recognition is paramount because outcome depends greatly on the speed with which therapy is initiated. Patients with meningitis and CSF findings of low glucose, elevated protein and pleocytosis with evidence of tuberculosis elsewhere in the body (chest radiographs, positive tuberculin skin test), or a history of exposure to tuberculosis should be treated immediately with antituberculous medication. When the diagnosis remains uncertain, serial examination of the CSF for tuberculous organisms will often yield positive results. The CT scan may show hydrocephalus, a basilar arachnoiditis, or intraparenchymal lesions: tuberculomas. Hydrocephalus may respond to early shunting. Tuberculomas are best treated medically. Therapy should include INH and rifampin; ethambutol and pyrazinamide are suggested for the first 2 months of therapy. Steroids may be useful in diminishing the inflammatory response when altered consciousness or focal neurologic signs are present.