Mycobacterium tuberculosis Meningitis and Other Etiologies of the Aseptic Meningitis Syndrome

ABSTRACT

Mycobacterium tuberculosis is one of the most common infectious agents in the world. It causes an insidious form of meningitis characterized by headache, low-grade fever, stiff neck and cranial nerve palsies, and an acute meningoencephalitis characterized by coma, raised intracranial pressure, seizures, and focal neurological deficits. This review focuses on the diagnosis and therapy of the insidious form of tuberculous meningitis and discusses the differential diagnosis of infectious and noninfectious etiologies of the aseptic meningitis syndrome.

KEYWORD

Tuberculosis - aseptic meningitis syndrome - cerebrospinal lymphocytic pleocytosis

REFERENCES

• 1 Starke J R. Tuberculosis of the central nervous system in children.  Semin Pediatr Neurol . 1999;  6 318-331
• 2 Marra C M. Bacterial and fungal brain infections in AIDS.  Semin Neurol . 1999;  19 177-184
• 3 Garcia-Monco J C. Central nervous system tuberculosis.  Neurol Clin . 1999;  17 737-759
• 4 Molavi A, LeFrock J L. Tuberculous meningitis.  Med Clin North Am . 1985;  69 315-331
• 5 Leonard J M, Des Prez R M. Tuberculous meningitis.  Infect Dis Clin North Am . 1990;  4 769-797
• 6 Slavin R E, Walsh T J, Pollack A D. Late generalized tuberculosis: a clinical and pathologic analysis and comparison of 100 cases in preantibiotic and antibiotic eras.  Medicine (Baltimore) . 1980;  59 352-366
• 7 Ober W B. Ghon but not forgotten: Anton Ghon and his complex.  Pathol Annu . 1983;  18 79-85
• 8 Lincoln E M, Sordillo V R, Davies P A. Tuberculous meningitis in children: a review of 167 untreated and 74 treated patients with special reference to early diagnosis.  J Pediatr . 1960;  57 803-823
• 9 Berenguer J, Moreno S, Laguna F, Vicente T. Tuberculous meningitis in patients infected with the human immunodeficiency virus.  N Engl J Med . 1992;  326 668-672
• 10 Marra C M, Critchlow C W, Hook E W, Collier A C, Lukehart S A. Cerebrospinal fluid treponemal antibodies in untreated early syphilis.  Arch Neurol . 1995;  52 68-72
• 11 Case records of the Massachusetts General Hospital (Case 35, 1998). N Engl J Med .  1998;  339 1534-1541
• 12 Stern B J, Krumholz A, Johns C, Scott P, Nissim J. Sarcoidosis and its neurologic manifestations.  Arch Neurol . 1985;  42 909-917
• 13 Newman L S, Rose C S, Maier L A. Sarcoidosis.  N Engl J Med . 1997;  336 1224-1234
• 14 Borucki S J, Nguyen B V, Ladoulis C T, McKendall R R. Cerebrospinal fluid immunoglobulin abnormalities in neurosarcoidosis.  Arch Neurol . 1989;  46 270-273
• 15 Scott T F, Seay A R, Goust J M. Pattern and concentration of IgG in cerebrospinal fluid in neurosarcoidosis.  Neurology . 1989;  39 1637-1639
• 16 Kinnman J, Link H. Intrathecal production of oligoclonal IgM and IgG in CNS sarcoidosis.  Acta Neurol Scand . 1984;  69 97-106
• 17 Oksanen V, Fyhrquist F, Somer H, Gronhagen-Riska C. Angiotensin converting enzyme in cerebrospinal fluid: a new assay.  Neurology . 1985;  35 1220-1223
• 18 Schweisfurth H, Schioberg-Schiegnitz S, Kuhn W, Parusel B. Angiotensin-I-converting enzyme in cerebrospinal fluid of patients with neurologic diseases.  Klin Wochenschr . 1987;  65 995-958
• 19 Seem C PC, Norfolk G, Spokes E G. CSF angiotensin-converting enzyme in neurosarcoidosis.  Lancet . 1985;  1 456-457
• 20 Recht L D. Neurologic complications of systemic lymphoma.  Neurol Clin . 1991;  9 1001-1015
• 21 Wasserstrom W R, Glass J P, Posner J B. Diagnosis and treatment of leptomeningeal mestastases from solid tumors: experience with 90 patients.  Cancer . 1982;  49 759-772
• 22 Theodore W H, Gendelman S. Meningeal carcinomatosis.  Arch Neurol . 1981;  38 696-699
• 23 Little J R, Dale A JD, Okazaki H. Meningeal carcinomastosis: clinical manifestations.  Arch Neurol . 1974;  30 138-143
• 24 Glantz M J, Cole B F, Glantz L K. Cerebrospinal fluid cytology in patients with cancer: minimizing false-negative results.  Cancer . 1998;  82 733-739
• 25 Moriarty A T, Wiersema L, Snyder W, Kotylo P K, McCloskey D W. Immunophenotyping of cytologic specimens by flow cytometry.  Diagn Cytopathol . 1993;  9 252-258
• 26 Moore P M. Neurological manifestations of vasculitis: update on immunopathogenic mechanisms and clinical features.  Ann Neurol . 1995;  S131-S141 (S131-S141)
• 27 Nishino H, Rubino F A, DeRemee R A, Swanson J W, Parisi J E. Neurological involvement in Wegener's granulomatosis: an analysis of 324 consecutive patients at the Mayo Clinic.  Ann Neurol . 1993;  33 4-9
• 28 Sneller M C, Fauci A S. Pathogenesis of vasculitis syndromes.  Med Clin North Am . 1997;  81 221-242
• 29 Jinnah H A, Dixon A, Brat D J, Hellmann D B. Chronic meningitis with cranial neuropathies in Wegener's granulomatosis.  Arthritis Rheum . 1997;  40 573-577
• 30 Martin M A, Massanari M, Nghiem D D, Smith J L, Corry R J. Nosocomial aseptic meningitis associated with OKT3.  JAMA . 1988;  259 2002-2005
• 31 Haas E J. Trimethoprim-sulfamethoxazole: another cause of recurrent meningitis.  JAMA . 1984;  252 252-346
• 32 Garagusi V F, Neefe L I, Mann O. Acute meningoencephalitis associated with isoniazid administration.  JAMA . 1976;  235 1141-1142
• 33 Moris G, Garcia-Monco J C. The challenge of drug-induced aseptic meningitis.  Arch Intern Med . 1999;  159 1185-1194
• 34 Sakane T, Takeno M, Suzuki N, Inaba G. Behçet's disease.  N Engl J Med . 1999;  341 1284-1291
• 35 Committee on Infectious Diseases. Chemotherapy for tuberculosis in infants and children.  Pediatrics . 1992;  89 161-164