Tuberculous Meningitis: Literature Review

Background: Tuberculous meningitis is the most severe form of M.tuberculosis infection, and occurs when there is an invasion of the membranes and cerebrospinal fluid by the bacteria. It develops as a complication of primary infection and reactivation in immunosuppressed. Objectives: This study aims to characterize tuberculous meningitis and bring updates. Design and setting: This is a literature review from the Escola de Medicina Souza Marques‘s students, Brazil. Methods: The used articles were published between 2012 and 2021, from the UpToDate, Scielo, PubMed, and Google Scholar databases. Results: Relevant epidemiological factors, such as HIV, and the absence of the Tuberculosis vaccine could raise the diagnosis hypothesis for the disease. Furthermore, clinical features as headaches, myalgia, fever, emesis, and sudden mood swings are also red flags. Patients should always be tested for HIV infection since mortality in these cases is about 60%. Tuberculous meningitis has a high lethality due to the delay in diagnosis and, in the absence of therapeutics, it worsens the prognosis. The complications are hydrocephalus, cranial nerve paralysis, strabismus, and coma. The diagnostic methods include CSF examination, computed tomography, magnetic resonance imaging, and GeneXpert. The treatment consists of antituberculosis therapy with glucocorticoids. Conclusions: It is essential to identify the disease and start immediate treatment, in addition to emphasizing the BCG vaccine and HIV prevention to reduce cases.