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Corticosteroids inTuberculous Meningitis

Nurdjaman NurimabaDept. of Neurology Hasan Sadikin Hospital

Faculty of Medicine, University of Padjadjaran

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INTRODUCTION

Tuberculous Meningitis (TBM) is an inflammation

of the Meninges.

Covering the brain and spinal cord

Caused by infectionMycobacterium tuberculosis

Condition usually present headache, fever,

convulsion Confirmation by microscopic and culture of the

spinal fluids

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Each year around 80.000 people contact TBM

28.000 of those die and a further 12.000 are

left with severe disability

TBM is a global problem, it is particularly

prevalent in developing world

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Monotherapy with Streptomicyn reduce the case

fatality rate to 63% (Parson 1988)

Combination (Isoniazid, Rifampicin and

Pyrazinamide) fatality rate varying from 20% to

32% with permanent neurological deficit 5% to40% (Jacob, 1990; Alarcon, 1990; Ramchandran,

1986)

Doctors have used corticosteroids for TBM since

the 1950s but their role remains controversial

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The corticosteroids used in different

study were :

Dexamethasone (OToole 1969, Girgis 1991,

Kumarvelu 1994, Lardizabal 1998, Thwaites

GE et al 2004)

Prednisolone (Chotmongkol 1996, Schoeman1997)

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Steroids may :

Decreased inflammation, especially in

arachnoid space

Reduced cerebral and spinal cord oedema(Parson 1988, Feldman 1958)

Reduced inflammation of small blood vessels

and therefore reduce damage from blood flow

slowing to the underlying brain tissue

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On the other hand, it is possible that steroids may

harm for patients :Suppress the immune response to Mycobacteria,

making the systemic effect worse

Reduced inflammation of the meningen, reducing drug

penetration into the subarachnoid space

In study reported Gastrointestinal hemorrhage (5

episodes), Glycosuria (1 episodes), infection (2

episodes) and hypothermia ( 5 episodes ) in 11 patientsreceiving dexamethasone (OToole 1969)

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Reaction to steroid use among 25 patients

were (Lardizabal 1998) :Cushingoid features (20)

Increased appetite (15)Dermatoses (6)

Psychoses (1)

Gastrointestinal bleeding (1)

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Adverse Events (Thwaites GE et al, 2004) :

Significantly were reported in placebo group than indexamethasone group (214 of 271 vs 186 of 274) p