Pulmonary tuberculosis with meningitis

Abstract

We read with great interest the case report by GoicBarisic et al. [1] on “pulmonary tuberculosis with meningitis in a 7-month-old infant”. The case report provides an excellent overview of the pathogenesis and diagnosis of tuberculosis meningitis. It also rightly emphasizes the importance of screening and introducing chemoprophylaxis in infants exposed to patients with active tuberculosis as well as early discovery and therapy of the illness. We would like to share our views in this regard. Tuberculous meningitis though rare in Croatia, is seen commonly in developing countries like India. Other serious forms of extrapulmonary tuberculosis like spinal tuberculosis, abdominal tuberculosis are also frequently encountered. One of the reasons for this might be the increase in the number of human immunodeficiency virus cases, which causes decreased immunity and dissemination of tuberculosis to different parts of the body. Other factors contributing are overcrowding, delay in diagnosis and inadequate health facilities [2]. As per World Health Organization guidelines for treatment of tuberculous meningitis by Directly Observed Therapy Short Course, isoniazid, rifampin, pyrazinamide and streptomycin are given for 2 months followed by isoniazid and rifampicin for the next 4 months. Countries applying Directly Observed Thera-