Meningitis caused by Mycobacterium tuberculosis in a recent immigrant to Canada

Tuberculosis (TB) of the central nervous system accounts for 1%-2% of all TB cases, causing a spectrum of disease that includes brain abscess, cerebritis, meningitis, myelitis and tuberculomas. TB meningitis is the most common central nervous system manifestation, with substantial morbidity (25%) and mortality (15%-40%) rates, even with appropriate treatment. TB meningitis typically presents subacutely, with fever, headache, malaise and personality changes, which can progress to cranial nerve palsies or other focal neurologic deficits, seizures, coma and death. Lumbar puncture is vital, as cerebrospinal fluid (CSF0 findings can be suggestive of a diagnosis of TB meningitis and prompt the decision to start empiric therapy. Typical CSF findings include an elevated opening pressure, marked lymphocytic pleocytosis, elevated protein caused by obstructed CSF flow, and low glucose. Here, Komorowski et al examine the case of 37-year-old woman with TB meningitis.