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Meningitis - tuberculous

Show Alternative Names
Tubercular meningitis
TB meningitis

Tuberculous meningitis is an infection of the tissues covering the brain and spinal cord (meninges).

Causes

Tuberculous meningitis is caused by Mycobacterium tuberculosis. This is the bacterium that causes tuberculosis (TB). The bacteria spread to the brain and spine from another place in the body, usually the lung.

Tuberculous meningitis is very rare in the United States. Most cases are in people who traveled to the United States from other countries where TB is common.

People who have the following have a higher chance of developing tuberculous meningitis:

Symptoms

The symptoms often start slowly, and may include:

Other symptoms that can occur with this disease may include:

  • Agitation
  • Bulging fontanelles (soft spots) in babies
  • Decreased consciousness
  • Poor feeding or irritability in children
  • Unusual posture, with the head and neck arched backward (opisthotonos). This is usually found in infants (less than 3 months old)

Exams and Tests

Your health care provider will examine you. This will usually show that you have the following:

  • Fast heart rate
  • Fever
  • Mental status changes
  • Stiff neck

A lumbar puncture (spinal tap) is an important test in diagnosing meningitis. It is done to collect a sample of cerebrospinal fluid for examination. More than one sample may be needed to make the diagnosis.

Other tests that may be done include:

Treatment

You will be given several medicines to fight the TB bacteria. Sometimes, treatment is started even if your provider thinks you have the disease, but testing has not confirmed it yet.

Treatment usually lasts for at least 12 months. Medicines called corticosteroids may also be used.

Outlook (Prognosis)

Tuberculous meningitis is life threatening if untreated. Long-term follow-up is needed to detect recurring infections.

Possible Complications

Untreated, the disease can cause any of the following:

  • Brain damage
  • Build-up of fluid between the skull and brain (subdural effusion)
  • Hearing loss
  • Hydrocephalus (build-up of fluid inside the skull that leads to brain swelling)
  • Seizures
  • Death

When to Contact a Medical Professional

Call 911 or the local emergency number or go to an emergency room if you suspect meningitis in a young child who has the following symptoms:

  • Feeding problems
  • High-pitched cry
  • Irritability
  • Persistent unexplained fever

Call the local emergency number if you develop any of the serious symptoms listed above. Meningitis can quickly become a life-threatening illness.

Prevention

Treating people who have signs of a non-active (dormant) TB infection can prevent its spread. A PPD test and other TB tests can be done to tell if you have this type of infection.

Some countries with a high incidence of TB give people a vaccine called BCG to prevent TB. But, the effectiveness of this vaccine is limited, and it is not usually used in the United States. The BCG vaccine may help prevent severe forms of TB, such as meningitis, in very young children who live in areas where the disease is common.

Review Date: 11/10/2024

Reviewed By

Jatin M. Vyas, MD, PhD, Professor in Medicine, Harvard Medical School; Associate in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

References

Bailey TC, Philips JA. Tuberculosis. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 299.

Centers for Disease Control and Prevention website. Tuberculosis (TB). www.cdc.gov/tb/index.html. Updated January 17, 2025. Accessed March 13, 2025.

Cruz AT, Starke JR. Tuberculosis. In: Cherry JD, Kaplan SL, Harrison GJ, Steinbach WJ, Hotez PJ, Williams JV, eds. Feigin and Cherry's Textbook of Pediatric Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2025:chap 96.

Fitzgerald DW, Sterling TR, Haas DW. Mycobacterium tuberculosis. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 249.

Disclaimer

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. No warranty of any kind, either expressed or implied, is made as to the accuracy, reliability, timeliness, or correctness of any translations made by a third-party service of the information provided herein into any other language. © 1997- A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

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Meninges of the brain - Illustration Thumbnail

Meninges of the brain

The organs of the central nervous system (brain and spinal cord) are covered by connective tissue layers collectively called the meninges. Consisting of the pia mater (closest to the CNS structures), the arachnoid and the dura mater (farthest from the CNS), the meninges also support blood vessels and contain cerebrospinal fluid. These are the structures involved in meningitis, an inflammation of the meninges, which, if severe, may become encephalitis, an inflammation of the brain.

Illustration

Meninges of the spine - Illustration Thumbnail

Meninges of the spine

The organs of the central nervous system (brain and spinal cord) are covered by 3 connective tissue layers collectively called the meninges. Consisting of the pia mater (closest to the CNS structures), the arachnoid and the dura mater (farthest from the CNS), the meninges also support blood vessels and contain cerebrospinal fluid. These are the structures involved in meningitis, an inflammation of the meninges, which, if severe, may become encephalitis, an inflammation of the brain.

Illustration

 
 
Meninges of the brain - Illustration Thumbnail

Meninges of the brain

The organs of the central nervous system (brain and spinal cord) are covered by connective tissue layers collectively called the meninges. Consisting of the pia mater (closest to the CNS structures), the arachnoid and the dura mater (farthest from the CNS), the meninges also support blood vessels and contain cerebrospinal fluid. These are the structures involved in meningitis, an inflammation of the meninges, which, if severe, may become encephalitis, an inflammation of the brain.

Illustration

Meninges of the spine - Illustration Thumbnail

Meninges of the spine

The organs of the central nervous system (brain and spinal cord) are covered by 3 connective tissue layers collectively called the meninges. Consisting of the pia mater (closest to the CNS structures), the arachnoid and the dura mater (farthest from the CNS), the meninges also support blood vessels and contain cerebrospinal fluid. These are the structures involved in meningitis, an inflammation of the meninges, which, if severe, may become encephalitis, an inflammation of the brain.

Illustration

 
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