14th June 2023

Tuberculous meningitis

Meningitis can be caused by infection with Mycobacterium tuberculosis. This should be particularly considered in those with higher risk, including immigration from high endemic areas, healthcare professionals, and those residing in prisons or hostels etc.

Tuberculous meningitis can present acutely, however, it mostly presents as a subacute or chronic form. Clinical features include fever, malaise, intermittent headaches, and cranial nerve palsies.

CSF analysis usually shows a high protein, low glucose and raised lymphocytes. Acid-fast bacilli may be seen and Mycobacterium tuberculosis may be grown on culture.

Treatment active tuberculous meningitis (Recommended duration is 9-12 months) 

High dose steroids can be added at the start of treatment, with gradual withdrawal recommended over 4-8 weeks.

NICE recommends treating as tuberculous meningitis in cases of direct spinal cord involvement in TB (e.g.

spinal cord tuberculoma) and also in patients with miliary TB with signs and symptoms suggestive of CNS involvement.