CASE PRESENTATION
ON
TUBERCULOSIS MENINGITIS
PRESENTED BY,
FERINA U
4th year PHARM D
DEPT OF PHARMACY PRACTICE
CG HOSPITAL ,DAVANGERE
INTRODUCTION
• Tuberculosis meningitis is a severe form of tuberculosis that affects the
meninges, the protective membranes surrounding the brain and spinal
cord.
CLINICAL MANIFESTATION
• Severe headache.
• High fever.
• Neck stiffness.
• Photophobia.
• Nausea and Vomiting.
• Seizures.
• Confusion or altered mental status.
SUBJECTIVE
DEMOGRAPHIC DETAILS OF THE PATIENT:
•A 35 year female patient was admitted to female emergency
ward with chief complaints of
Fever since 1 month.
Headache since 1 month.
Irritability since 1 week.
PERSONAL HISTORY
Diet : Mixed
Appetite : Decreased
Sleep : Disturbed
B&B : Disturbed
OBJECTIVE
On physical examination ,BP was130/90mmhg
PR was found 88 bpm and RR was 18cpm .His CVS
was S1 S2 heard and tachycardia. He was not
oriented on examination of his CNS . RS was B/L
NVBS +ve and his abdominal test showed soft ,non
tender and no organomegaly.
LABORATORY INVESTIGATION
PARAMETER OBSERVED VALUE NORMAL VALUE
S. Sodium 125mmol/l 137-145mmol/l
S. Creatinine 0.4 mg/dl 0.7- 1.2 mg/dl
RBC 5.0 ml/cmm 3.8-4.8 ml/cmm
PCV 38.9% 42-52%
MCV 78.5fl 83-101fl
WBC 12700mg/dl 4000-10000g/dl
CSF (Glucose) 105.0mg/dl 40-70mg/dl
CSF Protein 300mg/dl 12-60mg/dl
CSF Chloride 107.0mg/dl 123-135mg/dl
ASSESSMENT
PROVISIONAL DIAGNOSIS:-
TUBERCULOSIS MENINGITIS.
FINAL DIAGNOSIS:
TUBERCULOSIS MENINGITIS.
GOALS OF THE TREATMENT
• Prevent transmission.
• Supportive Care.
• Monitor and adjust treatment.
• Reduce mortality.
• Relieve symptoms.
PLAN
GENERIC NAME BRAND NAME DOSE ROU FREQ 28/0 29/ 30/0 31/0
TE 8 08 8 8
Pantoprazole Inj PAN 40mg IV 1-0-0
Ondansetron Inj EMESET 4mg IV 1-0-1 _ _
Dexamethason Inj DEXONA 4mg IV 1-0-1
e
Normal saline IVF NS 70ml/hr IV 1-1-0 _
Acetaminophe Inj PCT 1g IV S-O-S _
n
Isoniazid+ Tab . ATT 75mg+15 PO _ _
Rifampicin+ 0mg+400
Pyrazinamide+ mg+275m
Ethambutol g
Pyridoxine HCl T. BENADON 40mg PO 0-1-0 _
Ceftriaxone Inj XONE 2g IV 1-0-1
ABOUT MEDICATIONS
• ONDANSETRON belongs to a class of drug called anti-emetics which is used
to treat vomiting.
• CEFTRIAXONE belongs to a class of drugs called 3 rd generation cephalosporin
[Link] is used to prevent hospital acquired infections
• PANTOPRAZOLE: Proton pump inhibitors act in blocking acid secretion
and also have antioxidant and anti-inflammatory properties
• DEXAMETHASONE: It is a corticosteroid used to relieve inflammation and to
treat certain forms of arthritis.
• Benadon 40 mg Tablet 10's is used to treat vitamin B6 deficiency. It restores
vitamin B6 in the body and helps to treat its deficiency.
• rifampin, isoniazid, pyrazinamide, and ethambutol are FDA approved to
treat Mycobacterium tuberculosis infections.
DAY 2
• BP- 110/70 mm of Hg
• PR- 80bpm
• RR – 16cpm
• Temp – febrile
DAY 3
• BP-120/80 mm of hg
• PR- 80 BPM
• RR- 18cpm
• Temp – febrile
DAY 4
• BP-124/82mm of hg ,
• PR-82bpm
• RR – 18cpm
DISCHARGE MEDICATION
1) [Link] 40mg 1-0-0
2) [Link] 500mg 1-0-1 *2 Weeks
3) [Link] 1-0-1
ADVICE: Review in General Medicine OPD when symptoms occur.
PATIENT COUNSELLING
ABOUT DISEASE
Tuberculosis meningitis is a severe form of tuberculosis that
affects the meninges, the protective membranes surrounding the
brain and spinal cord
ABOUT DRUG
• Dexamethasone will decrease the level or effect of
ondansetron by affecting hepatic/intestinal
enzyme
• Dexamethasone will decrease the level or effect of
pantoprazole by affecting hepatic/intestinal
enzyme
ABOUT LIFESTYLE MODIFICATION:
• Maintain a balanced diet.
• Avoid alcohol and smoking.
• Vaccination.
• Practice good hygiene.
• Stress management.
• Stay well hydrated.
• Minimize close contact with others to prevent the spread of the
disease.
THANK YOU
