Tubercular Meningitis

Tubercular Meningitis

Question 1. Write a short note on tubercular meningitis.
Answer:

Meningitis is inflammatory involvement of the meninges

• Tubercular meningitis is a type of chronic meningitis.
• It causes chronic granulomatous reaction and may produce parenchymal lesions.
• Tuberculous meningitis occurs in children and adults through hematogenous spread of infection from tuberculosis elsewhere in the body or it may simply be a manifestation of military tuberculosis.
• Less commonly the spread may occur directly from tuberculosis of a vertebral body.

Tubercular meningitis

Tubercular Meningitis Pathologic Changes

• Grossly the subarachnoid space contains thick exudate particularly abundant in the sulci and the base of the brain.
• Tubercles are 1-2 mm in diameter, may be visible, especially adjacent to blood vessels.

Tubercular meningitis Microscopically

• It shows acute and chronic inflammatory cells and granulomas with or without caseation necrosis and giant cells.
• Acid-fast bacilli may be demonstrated.
• Late case show dense fibrous adhesions in the sub-arachnoid space and consequent hydrocephalus.

Tubercular meningitis Clinical Features

Headache, confusion, malaise and vomiting.

Tubercular meningitis CSF Findings

• Naked eye appearance of a clearer or slightly turbid CSF which may form a firing web on standing.
• Raised CSF pressure (greater than 300 mm water)
• Raised protein content
• Mononuclear leucocytosis
• Lower glucose concentration
• Tubercle bacilli may found on microscopy.

Tubercular meningitis CSF findings

Question 2. Write in brief pyemia and toxemia.
Answer:

Pyemia

It is the dissemination of small septic thrombi in the blood which cause their effcts at the site where they are lodged. This can result in pyemic abscess or septic infarcts.

1. Pyemic Abscess: They are multiple small abscesses in various organs such as in the cerebral cortex, myocardium, lungs and renal cortex.

Pyemic abscess shows a central zone of necrosis containing numerous bacteria surrounded by a zone of suppuration and an outer zone of acute inflammatory cells.

2. Septic Infarcts: It results from the lodgement of large fragments of septic thrombi in the arteries with relatively large foci of necrosis, suppuration and acute inflammation.

Toxemia

It is defined as the distribution throughout the body of poisonous products of bacteria growing in a focal or local site, thus producing generalized symptoms, i.e. fever, diarrhea, malaise, vomiting, quickened or depressed pulse, respiration and shock.