Modern concepts on the pathogenesis and therapy of tuberculous meningitis
Nikolić, S.
Srpski Arhiv Za Celokupno Lekarstvo 124(1-2): 24-28
1996
ISSN/ISBN: 0370-8179 PMID: 9102810 Document Number: 461797
The study concerned pathogenetic mechanisms of occurrence of tuberculous meningitis and modern recommendations for therapy. Meningitis has never been a primary localization of tuberculous infection, but the latter appears by dissemination from some primary, extrameningeal focus which is frequently clinically unapparent. The second possibility of meninegeal appearance is a rupture of subependymal tubercles into the subarachnoid area, discharge of their caseous content and transition of mycobacteria into liquor. These tubercles occurred by previous haematogenous dissemination in the preallergic phase of pulmonary primoinfection or reinfection, several months or years prior to meningeal appearance. Treatment of tuberculous meningitis lasts nine months; daily application of three or four antituberculous drugs is recommended for the first two months, and then intermittent therapy by isoniazid and Rifadin is continued during the following seven months. The results of this short-course, intermittent therapy are the same, or better, than the results of "standard" therapy which lasted 18-24 months.