Meningitis tuberkulosis merupakan infeksi selaput otak (meningen) yang disebabkan oleh bakteri Mycobacterium tuberculosis. Merupakan salah satu komplikasi tuberkulosis yang paling serius dan dapat menyebabkan morbiditas serta mortalitas yang tinggi pada orang dewasa maupun anak-anak bila tidak ditangani dengan cepat dan tepat.
Tanda dan Gejala
Tanda dan gejala Meningitis tuberkulosis bervariasi dan sering kali nonspesifik, terutama pada tahap awal. Gejala umum meliputi:
- Demam
- Sakit kepala yang berat dan persisten
- Mual dan muntah
- Kaku leher
- Penurunan kesadaran
- Kejang
- Penurunan fungsi neurologis, seperti kelemahan atau kelumpuhan
Patofisiologi
Patofisiologi Meningitis tuberkulosis dimulai dengan penyebaran hematogen Mycobacterium tuberculosis dari fokus infeksi primer. Bakteri kemudian menembus sawar darah-otak dan menginfeksi meninges. Infeksi ini menyebabkan respon inflamasi yang signifikan, menghasilkan eksudat yang dapat menutup aliran cairan serebrospinal (CSF), menyebabkan peningkatan tekanan intrakranial. Inflamasi juga dapat merusak pembuluh darah otak, menyebabkan stroke dan kerusakan jaringan otak.
Diagnostik
Diagnostik Meningitis tuberkulosis melibatkan beberapa langkah:
- Anamnesis dan Pemeriksaan Fisik: Riwayat kontak dengan penderita tuberkulosis dan gejala klinis.
- Pungsi Lumbal: Analisis CSF menunjukkan peningkatan tekanan, peningkatan jumlah sel darah putih, peningkatan protein, dan penurunan glukosa.
- Tes Laboratorium: Kultur bakteri, PCR, dan tes sensitivitas obat pada sampel CSF.
- Pencitraan: CT Scan atau MRI otak untuk mendeteksi komplikasi seperti hidrosefalus atau infark.
Penatalaksanaan
Penatalaksanaan Meningitis tuberkulosis mencakup:
- Terapi Antituberkulosis: Kombinasi obat antituberkulosis (isoniazid, rifampisin, pirazinamid, dan etambutol) selama 9-12 bulan.
- Kortikosteroid: Deksametason atau prednison untuk mengurangi inflamasi dan edema otak.
- Manajemen Komplikasi: Penanganan hidrosefalus dengan pemasangan shunt, terapi antikonvulsan untuk kejang, dan rehabilitasi neurologis.
Referensi:
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