Glucocorticoids in the treatment of patients with tuberculous meningitis — two sides of one medal (current trends, clinical case)

Abstract

Corticosteroids have long been used as an adjunct to the treatment of tuberculous meningitis. In addition, glucocorticoid therapy is an integral aspect of the management of patients with systemic connective tissue diseases, which is due to the high effectiveness of these drugs in reducing disease activity. Immunological defects in systemic connective tissue diseases, a high total dose of corticosteroids in therapy cause the activation of latent tuberculosis infection and the rapid development of the disease when infected with mycobacterium tuberculosis.The results of presented clinical case have shown that doctors of different specialties should be tuned to the probability of developing tuberculous meningitis in patients with immunosuppression, even in the absence of meningeal symptoms (rigidity of the occipital muscles, the symptom of Kernig) against the background of the use of glucocorticoids in the treatment of other diseases. At the same time, corticosteroids should be prescribed to patients as an adjuvant for anti‑TB therapy (despite immunosuppressive effects), but the regimen should be developed for each patient according to the individual severity of the disease. A molecular genetic method G‑Xpert demonstrated considerable molecular diagnostic value for the diagnosis of tuberculous meningitis. The method allows not only detect Mycobacterium tuberculosis in the cerebrospinal fluid in 2 hours but also determine the presence of multiple drug resistance, which contributes to the immediate administration of adequate etiotropic therapy which prevents the development of severe neurological disorders and death. Neuroimaging is essential for the diagnosis and monitoring of tuberculous meningitis.In cases of differential diagnosis of tuberculous meningitis, physicians should refrain from using broad‑spectrum drugs from fluoroquinolones and aminoglycosides, as this may cause untimely detection of a correct diagnosis.