Tuberculous Meningitis

         Tuberculous meningitis is an inflammation of the lining of the brain or meninges caused by the bacterium Mycobacterium tuberculosis. Tuberculous meningitis is the result of hematogenous spread of Mycobacterium tuberculosis and limfogen of primary infection in the lung.

        TB meningitis is one of the complications of primary TB. The morbidity and mortality of this disease is high and the prognosis is poor. TB meningitis complications occur every 300 cases of primary untreated tuberculosis. Centers for Disease Control (CDC) reported in 1990 of TB meningitis morbidity 6.2% of all cases of extrapulmonary TB. The incidence of TB meningitis is comparable with primary TB, is generally dependent on the socio-economic status, public hygiene, age, nutritional status and genetic factors that determine a person's immune response. Factors predisposing to the development of TB infection is malnutrition, corticosteroid use, malignancy, head injury, HIV infection and diabetes mellitus. This disease can affect all ages, children more often than adults, especially in the first 5 years of life. Rarely found in under 6 months of age and almost never found in under 3 months of age.

         Tuberculosis that attacks the CNS (Central Nervous System) is found in three forms, namely meningitis, tuberculomas, and spinal arachnoiditis. All three are often found in TB endemic countries, with most cases in the form of tuberculous meningitis. In the United States who is not a state of endemic tuberculosis, tuberculous meningitis include 1:100 of all cases of tuberculosis (8). In Indonesia, there are still many tuberculous meningitis due to tuberculosis morbidity in children is still high. This disease can affect all ages, including infants and young children with natural immunity is low. The highest incidence rates found in children aged 6 months to 4 or 6 years, is rarely found in less than 6 months of age, almost never found in under 3 months of age. Tuberculous meningitis affects 0.3% of children suffer from untreated tuberculosis.

        Tuberculous meningitis mortality rate in the range of 10-20%. Most of the remainder are asymptomatic, only 18% of patients who will return to normal neurological and intellectual. The incidence of pulmonary tuberculosis reported in Indonesia continues to increase every year and so far the country with the third highest in the case of pulmonary tuberculosis, in 2001, reported a change from previous years, pulmonary TB patients from 21 to 43 patients per 100,000 population, and patients with active Mycobacterium are found 83 people per 100,000 population.

         Around the world, tuberculosis is a major cause of morbidity and mortality in children. In the United States, the incidence of tuberculosis is less than 5% of all cases of bacterial meningitis in children, but the disease has a higher frequency in areas with poor sanitation, tuberculosis meningitis if left untreated, the mortality rate will increase, usually within a period of three to five weeks. The incidence increases with increasing number of adult tuberculosis patients.