Tuberculosis (TB) is a contagious, airborne disease that typically affects the lungs. TB is caused by a bacterium called Mycobacterium tuberculosis. If the infection is not treated quickly, the bacteria can travel through the bloodstream to infect other organs and tissues. Sometimes, the bacteria will travel to the meninges, which are the membranes surrounding the brain and spinal cord. Infected meninges can result in a life-threatening condition known as meningeal tuberculosis. Meningeal tuberculosis is also known as tubercular meningitis or TB meningitis

1. CASE STUDY ON
Meningeal
TUBERCULOSIS
Presented By-
MAKBUL HUSSAIN CHODHURY
Pharm.D 5th year
H.T. No. 15Z11T0006

2. MENINGEAL TUBERCULOSIS
• Tuberculosis (TB) is a contagious, airborne disease that
typically affects the lungs. TB is caused by a bacterium
called Mycobacterium tuberculosis. If the infection is
not treated quickly, the bacteria can travel through the
bloodstream to infect other organs and tissues.
• Sometimes, the bacteria will travel to the meninges,
which are the membranes surrounding the brain and
spinal cord. Infected meninges can result in a life-
threatening condition known as meningeal tuberculosis.
Meningeal tuberculosis is also known as tubercular
meningitis or TB meningitis.

4. Sings and symptoms
• fatigue
• malaise
• low-grade fever
• fever
• confusion
• nausea and vomiting
• lethargy
• irritability
• unconsciousness

5. Diagnosis
o biopsy of the meninges
o blood culture
ochest X-ray
o CT scan of the head

6. Case
presentation

7. Patient details- Subjective
• IP NO: 731560169
• Patient name: XYZ
• Age: 18 years
• Gender: Female
• Weight: 40 kg
• Date of admission: 29/07/19
• Date of discharge: 06/08/19

8. Reason for admission- subjective
Chief Complain
• Chronic Headache from 15 days
• Vomiting
• fever
•Past Medical History- Not significant
•Past Medication History - Nil
•Family history: Nil
•Social history: non-alcoholic, non-smoker

9. Physical examination:-
• General condition -- sick
• CNS -- Conscious, well oriented
• CVS -- s1 & s2 +ve
• Chest -- normal breathing
• P/A -- soft , non tender ,
non distended,
no organomegaly

10. Laboratorydata
Investigation 30/07/19 02/08/19 Normal Values
Creatinine (L) 0.7 0.8- 1.5 mg/dl
Hb (L) 12.1 13-17 gm/dl
RBC (L) 3.38 4.5 – 5.5
millions/cu.mm
PCV (L) 36.5 40-50 %
MCV (L) 78 83-99 fl/red cell
MCH (H) 35.8 27-33 pg/cell
ESR (H) 25 Less than
15mm/hr.
TLC (L) 4240 4000-11000
/cu.mm

11. Investigation 30/07/19 02/08/19 Normal Values
Sodium (L) 130 137-145 mmol/l
Neutrophil (H) 83 44-68 %
Lymphocyte (L) 15 25-45 %
Eosinophil (L) 0 1-6%
Laboratorydata

12. Other Investigations
• CT scan: fronto temporal edema.
• MRI: left frontoparieral region with significat
perilesional edema and extension of edema in left
gangliocapsular region.

13. Final Diagnosis
MENINGEAL TUBERCULOSIS

14. DayToDayAssessment
o Day 1-
c/o-
o chronic Headache on and
off from 15 days.
o vomiting
Medication-
Tab. Calpol (paracetamol)
650 mg SOS
Vitals-
NORMAL
Advice:
Chest x-ray

15. oDay 2-
Pt.stable
Montox reactive
Vitals normal
Rx-
Inj. Mannitol 200ml over 1
hr.
Tab.Rantac (Ranitidine)
50mg BD
Adv.- CT scan brain
o Day 3-
c/o- involuntary shaking
of right hand fingers
Vitals: Normal
Rx-
Inj. Dexamethasone 6mg iv
6 hrly.
Tab.rifampicin+isoniazid
(450+300mg OD)
Tab.Ethambutol 800mg OD
Tab.Pyrazinamide 750mg BD
Tab.shelcal OD

16. • Day 4-
C/O –same
stop Mannitol
Rest CST
oDay 5-
Advice: ivF DNS 500ml+5ml kcl
12 hrly
Rest
Rx-
Rest CST
oDay 6-
C/O – Pain in abdomen
Advice:
ivF Stop Rantac 100mg
o Day 7-
patient better Rest
o Day 8-
No fresh complaints
patient stable
patient discharged

17. MEDICATION CHART
Name, strength, route,
frequency
Date
started
Date Class
stopped
Inj.Mannitol 200ml
IV (1hr)
30/07/19 03/08/19 Osmotic diuretic
Tab.Paracetamol 650mg
SOS
29/07/19 SOS Analgesic,antipyretic
Tab. Ranitidine 50mg
oral BD
30/07/19 05/08/19 H2-blocker
Tab.Methylprednisolone
40mg PO BD
05/08/17 06/08/19 Corticosteroid
Inj. Dexamethasone 6mg
iv 6 hrly.
02/08/17 04/08/19 Corticosteroid

18. MEDICATION CHART
Name, strength, route,
frequency
Date
started
Date Class
stopped
Tab.Rifampicin + Isoniazid
(450+300mg)
Oral OD
02/08/19 Antibiotic,
Nicotinic acid
derivative
Tab. Ethambutol (800mg)
Oral OD
02/08/19 antimicrobial
Tab. Pyrazinamide (750mg)
Oral BD
02/08/19 Antibiotic,
Nicotinic acid
derivative
Tab. Ca.carbonate + vit.D3
Oral OD
02/02/19 Nutrition

19. CLINICAL JUSTIFICATION
• Mannitol was given for edema in the temporal region.
• Corticosteroids help to reduce inflammation of the surface of the
brain and associated blood vessels, and are thought to decrease
pressure inside the brain and thus reduces the risk of death.
• Pyridoxine should be given with Isoniazid.
• Isoniazid interferes competitively with pyridoxine metabolism by
inhibiting the formation of the active form of the vitamin, and
hence often results in peripheral neuropathy.

20. DISCHARGE SUMMARY-
• Tab.Rifampicin + Isoniazid (450+300mg) OD for 4 months
• Tab. Ethambutol (800mg) OD for 2 months
• Tab. Pyrazinamide (750mg) BD for 2 months
• Tab. Ca.carbonate + vit.D3 OD

21. Patient counselling
• Adherance to the drugs.
• Non-adherance to tuberculosis treatment can lead to
prolonged periods of infectiousness, relapse, emergence of
drug-resistance and increased mortality and morbidity.

22. •Thank You