Tuberculous Meningitis
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Tuberculous meningitis (TBM) develops in 2 steps. Mycobacterium tuberculosis bacilli enter the host by droplet inhalation. Localized infection escalates within the lungs, with dissemination to the regional lymph nodes. In persons who develop TBM, bacilli seed to the meninges or brain parenchyma, resulting in the formation of small subpial or subependymal foci of metastatic caseous lesions, termed Rich foci. The second step in the development of TBM is an increase in size of a Rich focus until it ruptures into the subarachnoid space. The location of the expanding tubercle (ie, Rich focus) determines the type of CNS involvement. Tubercles rupturing into the subarachnoid space cause meningitis. (See Pathophysiology.) Currently, more than 2 billion people (ie, one third of the world’s population) are infected with tuberculosis (TB), of which approximately 10% will develop clinical disease. The incidence of central nervous system (CNS) TB is related to the prevalence of TB in the community, and it is still the most common type of chronic CNS infection in developing countries. Despite great advances in immunology, microbiology, and drug development, TB remains among the great public health challenges. Poverty; lack of functioning public health infrastructure; lack of funding to support basic research aimed at developing new drugs, diagnostics, and vaccines; and the co-epidemic of HIV continue to fuel the ongoing epidemic of TB. (See Epidemiology.) TBM is a very critical disease in terms of fatal outcome and permanent sequelae, requiring rapid diagnosis and treatment. Prediction of prognosis of TBM is difficult because of the protracted course, diversity of underlying pathological mechanisms, variation of host immunity, and virulence of M tuberculosis . Prognosis is related directly to the clinical stage at diagnosis. (See Prognosis.) Meningitis TB (TBM) berkembang dalam 2 langkah. Mycobacterium tuberculosis bacilli memasuki dengan tetesan inhalasi. Infeksi lokal meningkat dalam paru-paru, dengan penyebaran ke kelenjar getah bening regional. Pada orang yang mengembangkan TBM, benih basil meninges atau parenkim otak, sehingga pembentukan subpial kecil atau subependymal fokus lesi caseous metastasis, disebut Rich foci. Langkah kedua dalam pengembangan TBM adalah peningkatan ukuran rich sampai pecah ke dalam ruang subarachnoid. Lokasi tuberkulum berkembang (yaitu, rich focus ) menentukan jenis keterlibatan SSP. Tuberkel pecah ke dalam subarachnoid ruang
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Transcript of Tuberculous Meningitis
Tuberculous meningitis (TBM) develops in 2 steps.Mycobacterium tuberculosisbacilli enter the host by droplet inhalation. Localized infection escalates within the lungs, with dissemination to the regional lymph nodes. In persons who develop TBM, bacilli
Tuberculous meningitis (TBM) develops in 2 steps.Mycobacterium tuberculosisbacilli enter the host by droplet inhalation. Localized infection escalates within the lungs, with dissemination to the regional lymph nodes. In persons who develop TBM, bacilli seed to the meninges or brain parenchyma, resulting in the formation of small subpial or subependymal foci of metastatic caseous lesions, termed Rich foci.The second step in the development of TBM is an increase in size of a Rich focus until it ruptures into the subarachnoid space. The location of the expanding tubercle (ie, Rich focus) determines the type of CNS involvement. Tubercles rupturing into the subarachnoid space cause meningitis. (See Pathophysiology.)Currently, more than 2 billion people (ie, one third of the worlds population) are infected with tuberculosis (TB), of which approximately 10% will develop clinical disease. The incidence of central nervous system (CNS) TB is related to the prevalence of TB in the community, and it is still the most common type of chronic CNS infection in developing countries.Despite great advances in immunology, microbiology, and drug development, TB remains among the great public health challenges. Poverty; lack of functioning public health infrastructure; lack of funding to support basic research aimed at developing new drugs, diagnostics, and vaccines; and the co-epidemic of HIV continue to fuel the ongoing epidemic of TB. (See Epidemiology.)TBM is a very critical disease in terms of fatal outcome and permanent sequelae, requiring rapid diagnosis and treatment. Prediction of prognosis of TBM is difficult because of the protracted course, diversity of underlying pathological mechanisms, variation of host immunity, and virulence ofM tuberculosis. Prognosis is related directly to the clinical stage at diagnosis. (See Prognosis.)Meningitis TB (TBM) berkembang dalam 2 langkah. Mycobacterium tuberculosis bacilli memasuki dengan tetesan inhalasi. Infeksi lokal meningkat dalam paru-paru, dengan penyebaran ke kelenjar getah bening regional. Pada orang yang mengembangkan TBM, benih basil meninges atau parenkim otak, sehingga pembentukan subpial kecil atau subependymal fokus lesi caseous metastasis, disebut Rich foci.
Langkah kedua dalam pengembangan TBM adalah peningkatan ukuran rich sampai pecah ke dalam ruang subarachnoid. Lokasi tuberkulum berkembang (yaitu, rich focus ) menentukan jenis keterlibatan SSP. Tuberkel pecah ke dalam subarachnoid ruang penyebab meningitis.
Menurut WHO , 2003 lebih dari 2 miliar orang (yaitu, sepertiga dari populasi dunia) terinfeksi tuberkulosis (TB), dimana sekitar 10% akan mengembangkan penyakit klinis. Insiden sistem saraf pusat (SSP) TB terkait dengan prevalensi TB di masyarakat, dan masih jenis yang paling umum dari infeksi SSP kronis di negara berkembang.
Meskipun kemajuan besar dalam imunologi, mikrobiologi, dan pengembangan obat, TB masih merupakan salah satu tantangan kesehatan masyarakat yang besar. Kemiskinan; kurangnya infrastruktur kesehatan masyarakat fungsi; kurangnya dana untuk mendukung penelitian dasar bertujuan untuk mengembangkan obat baru, diagnostik, dan vaksin; dan co-epidemi HIV terus mendorong epidemi yang sedang berlangsung dari TB. (Lihat Epidemiologi.)
TBM adalah penyakit yang sangat penting dalam hal hasil yang fatal dan gejala sisa permanen, membutuhkan diagnosis yang cepat dan pengobatan. Prediksi prognosis TBM sulit karena tentu saja berlarut-larut, keragaman mekanisme yang mendasari patologis, variasi kekebalan host, dan virulensi tuberkulosis M. Prognosis berhubungan langsung dengan stadium klinis pada diagnosis. (Lihat Prognosis.)
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http://www.meningitis.org/disease-info/types-causes/tb-meningitishttp://www.who.int/mediacentre/factsheets/who104/en/print.htmlhttp://www.who.int/mediacentre/factsheets/fs104/en/http://katumbu.blogspot.com/2012/08/konsep-dasar-meningitis-tb.htmlhttp://notleacher.blogspot.com/2013_06_01_archive.htmlhttp://ispn.guide/book/The%20ISPN%20Guide%20to%20Pediatric%20Neurosurgery/Infections%20in%20the%20Nervous%20System%20of%20Children/Meningitis%20And%20Ventriculitis%20In%20The-8http://ispn.guide/
