TB (tuberculosis) meningitis

On this page you’ll find an overview of meningitis caused by Mycobacterium tuberculosis bacteria, the germ that also causes tuberculosis (TB).

• TB meningitis is caused by Mycobacterium tuberculosis, a bacteria that is found all around the world.
• TB meningitis is relatively uncommon in high-income countries. 70% of global cases occur in Southeast Asia and Africa.
• Mycobacterium tuberculosis usually affects the lungs first, but can spread to other areas of the body. When it affects the lining of the brain and spinal cord, it causes TB meningitis.
• TB meningitis is harder to diagnose than other types of bacterial meningitis because it’s much slower to develop.
• The duration of treatment for TB meningitis is much longer than for other types of bacterial meningitis. 
• Some TB bacteria have developed resistance against some antibiotics, which can make the duration of treatment even longer.

What is TB meningitis?

TB meningitis (sometimes referred to as TBM) is the swelling of the membranes, called meninges, that cover and protect the brain and spinal cord. It’s caused by the bacteria Mycobacterium tuberculosis. This bacteria also causes tuberculosis (TB). 

Mycobacterium tuberculosis infects the lungs first. If the bacteria travels through the bloodstream to the lining of the brain and spinal cord, they can form small abscesses. Symptoms of meningitis will appear when these abscesses burst. 

What are the symptoms of TB meningitis?

TB meningitis normally begins with vague, non-specific symptoms such as:

• Aches and pains.
• Low-grade fever.
• Generally feeling unwell.
• Tiredness / irritability.
• Not being able to sleep or eat properly.
• Gradually worsening headache.

• Vomiting.
• Severe headache.
• Dislike of bright light.
• Stiff neck (less common in young children).
• Seizures (fits).

Without medical treatment, the disease will progress and you will eventually fall into a coma.  TB meningitis is harder to diagnose than other types of bacterial meningitis because it’s much slower to develop. It takes much longer for Mycobacterium tuberculosis to double in number compared to other causes of bacterial meningitis.

Check regularly on someone who is unwell. Always trust your instincts. If you suspect TB meningitis, seek medical help straight away for rapid diagnosis and treatment

How do you get TB meningitis?

Mycobacterium tuberculosis are the bacteria that cause TB and are contagious. The bacteria can enter your body if you’re near to someone with an active TB infection in their lungs when they cough or sneeze.

Who can get TB meningitis?

TB meningitis can affect anyone, but some people are more at risk than others, including:

• Young children up to four years of age.³
• People with medical conditions that affect their immune systems, or who are having treatment that weakens their immune system.
• People affected by undernutrition.
• Homeless people or people living in poorly ventilated or overcrowded accommodation. TB spreads more easily in these conditions.

How is TB meningitis treated?

TB meningitis is treated with antibiotics.

When you get to hospital, the doctor may do a lumbar puncture (LP) to help diagnose meningitis. A lumbar puncture involves taking a sample of cerebrospinal fluid from the spinal canal (the space through the back bones which contains the spinal cord). A lumbar puncture is important to confirm the diagnosis of meningitis. It will also show which germ is causing the illness so doctors can choose the most appropriate treatment.

The World Health Organization (WHO) have guidelines for:

• The treatment of TB in children and adolescents
• The treatment of drug susceptible TB
• The treatment of drug resistant TB

Treatment for TB meningitis usually involves taking a combination of four different antibiotics over a twelve-month period. Treatment with steroids for the first six to eight weeks is also recommended. Children who have a low risk of having drug-susceptible TB will sometimes have a more intensive treatment over six months. As treatment durations are long, you can usually receive support in the community to help you maintain your treatment.

It’s very important to take your medication every day and complete the entire course of antibiotics. Missing doses or stopping treatment early can cause the TB infection to become resistant to antibiotics.

Treatment for drug-resistant TB may take longer and will depend on what drugs the bacteria is resistant to.

Some countries use clinical guidelines that help doctors and healthcare providers decide what treatment to offer patients with TB meningitis (such as the UK’s National Institute for Health and Care Excellence guidelines). However, not all countries have these guidelines.

What are the after-effects of TB meningitis?

You can make a full recovery from TB meningitis without any lasting problems. But it’s a serious disease, and up to half of those who survive can be left with ongoing problems which may need further treatment and support.⁶

The possible after-effects of TB meningitis include:

• Learning and intellectual disabilities such as memory loss, lack of concentration or issues with thinking and problem solving.
• Clumsiness and co-ordination problems.
• Headaches.
• Deafness, hearing problems, tinnitus, dizziness or loss of balance.
• Epilepsy or seizures.
• Weakness, paralysis or spasms.
• Loss of sight or vision problems.
• Hydrocephalus (fluid on the brain).
• Mental health issues and changes to personality or behaviour.
• Difficulties with sleep.
• Fatigue.
• Anxiety and depression.

Is there any follow-up care after recovery from TB meningitis?

Treatment for TB meningitis usually goes on for a long time. There should be opportunities for you to discuss any concerns you have about your recovery with the doctors treating you.
 
Depending on your needs and your local health services, you may be referred to different teams of doctors and specialists to treat any ongoing after-effects that you have following TB meningitis.  
 
Follow-up care for babies and children is particularly important, along with tracking their development as they get older. Some long-term neurodevelopmental complications may not be noticeable until children reach certain milestones. Make sure to discuss any concerns you have about your child’s development with doctors.
 
Read more about the follow-up care after recovery from meningitis.

Can we prevent TB meningitis?

There is only one licensed vaccine available that provides some protection against TB, which is the Bacille Calmette-Guérin (BCG) vaccine. The BCG vaccine provides protection against TB meningitis in children. 

The BCG vaccine doesn’t protect against TB that causes lung disease in adults, and also doesn’t prevent the initial infection with the bacteria that cause TB. So, this means that it isn't effective at preventing the spread of the disease.

Early identification of TB infection and prompt treatment are key to stopping the transmission of disease.

Can I get a vaccine to protect me against TB meningitis?

The BCG world atlas provides information about BCG vaccination policies in most countries around the world.

In the UK, the BCG vaccine is only given to people at increased risk of coming into contact with TB.  Detailed information about who is offered BCG vaccine in the UK is available from the NHS website.