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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest treatment for tuberculous meningitis

Hi Doctor, My Wife is Tubercular Meningitis and she was treated 10 days from 15.11.2013 to 25.11.2013 in hospital including 2 day ICU due loss of control etc.In CSF test showed sugar 19mg/dl, Protein- 132 mg/dl, WBC count 40/cumm, N-65%,L-35% consitent with bacterial meningitis seen .CSF grew staph. aureus. CT head shows Normal Scan.MRI brain contrast shows focal area of cerebrities involving Left basal ganglia and temporal lobe region with diffuse meningitis.Multiple Ring enhancing lesion in both cerebral and cerebella hemisphere are likely tuberculous. She was on AKT 4 with Levoflox 750 & Benadon 20 mg medication from last 3 months including Wysolane 30 mg for 2 months. But from this month(19 Febraury ,2014) the doctor changed the medication from AKT 4 to R-Cinex 600/300 ,PZA,Benadone. . From last few days she is feeling lack of movement in both the legs including all joint pain with itching.Kindly suggest
Fri, 16 Dec 2016
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General & Family Physician 's  Response
Hi,
Thanks for your question. I do understand your pain and discomfort. I have seen many cases with similar complaints. Please find my advice below-:
1)As per your report it is meningitis but not mentioned it is tubercular.
2)Do a CSF culture and in culture it will be clarified that whether it is viral,fungal or Bacterial in origin if Bacterial then which Bacteria?
3)check following signs and symptoms of meningitis -:high fever,severe headache,stiff neck,vomiting and nausea ,confusion,seizures,sleepiness or difficulty waking up,sensitivity to light,lack of interest in eating,skin rash etc remember that all symptoms are not present to all patients.
4)besides infection meningitis can also occur in drug allergies,sarcoidosis,and some form of cancers.
5) The best antimicrobial agents in the treatment of Tubercular meningitis include isoniazid (INH), rifampin (RIF), pyrazinamide (PZA), and streptomycin (SM), all of which enter cerebrospinal fluid (CSF) readily in the presence of meningeal inflammation. These are first line drug of choice with addition of steroids.
Duration of treatment should be up to 2 years .

I hope I was able to address your query. If you have any further questions, please do not hesitate to write to me.
Wishing you all the best.
Thanks,
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