A 10-month-old child presents with 2 weeks history of fever, vomiting and alteration of sensorium. Cranial CT scan reveals basal exudates and hydrocephalus, the most likely etiological agent is:
- History suggests the diagnosis of Tuberculous meningitis caused by Mycobacterium tuberculosis - It is one of the most severe forms of TB Pathogenesis: Primary infection - Bacillemia - Seeding of meninges (RICH's FOCI)- Rupture -Tubercular meningitis Clinical features: Stages: 1. Prodromal stage (fever, anorexia, vomiting, irritability) 2. Focal deficits, seizures, meningeal signs 3. Coma, neurological sequelae Investigations: CNS IMAGING (CT Head) Basal exudates Image showing basal exudates Hydrocephalus Tuberculoma with perilesional edema CSF STUDY: Opening pressure elevated Cell count - 500/mm3 (lymphocytic predominance) Elevated proteins & Low glucose Cob-web coagulum Diagnosis is confirmed if CSF culture / PCR is +ve for mycobactacterium tuberculosis / acid fast bacilli TREATMENT - ATT + Steroids
Mycobacterium tuberculosis
Cryptococcus neoformans
Listeria monocytogenes
Streptococcus pneumoniae
CNS infections