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TB Meningitis Stages: The Importance of Early Detection

TB Meningitis Stages: The Importance of Early Detection

What is TB meningitis?

Tuberculosis (TB) meningitis or TBM is a severe form of tuberculosis. This occurs when the bacteria Mycobacterium tuberculosis, which normally infects the lungs, multiplies and enters the bloodstream. The bacteria then travel to the meninges, or the protective layers that cover the brain, and eventually infect the brain tissues. If not treated immediately, the infection can cause a rise in the pressure inside the skull. This may result in nerve and brain tissue damage.

TB Meningitis is more prevalent in children than in adults. People who are infected with tuberculosis and/or human immunodeficiency virus (HIV) are prone to suffering from TB meningitis. People who have a weak immune system are also prone to developing this disease.

TB meningitis progresses in three stages. Symptoms become more complicated as the disease gradually infects the body. It takes about 2-3 weeks for TB meningitis to manifest conclusive symptoms. As a person progresses through the three TB meningitis stages, the likelihood of permanent brain damage and death increases.

TB Meningitis Stages

Grade 1 – Non-specific symptoms

At this stage, a person infected with TB meningitis will manifest symptoms that can be associated with a lot of different diseases. A person can start with one of these symptoms and eventually manifest more as the disease progresses. Symptoms for grade 1 TB meningitis include:

  • Irritability – Person might seem like they are not in the mood and are easily agitated over noise, clutter, or movements.
  • Lethargy – Feeling weak or having lack of energy.
  • Headache – Pain in the head is persistent and does not go away.
  • Malaise – Feelings discomfort and uneasiness without any specific reason.
  • Fever – Low-grade fever (around 37.5°C to 38.3°C).
  • Nausea – Dizziness with a discomfort in the chest, abdomen and throat.
  • Vomiting – Persistent urge to vomit.

Grade 2 – Altered consciousness with minor focal neurological symptoms

At this stage, the patient will start to display signs and symptoms of dysfunction in the central nervous system (brain and the spinal cord).

  • Meningism – There is an inflammation in the protective barrier of the brain which causes headache, neck stiffness, and light sensitivity. There may also be nausea and vomiting.
  • Strabismus – There is a misalignment in the eye which makes the person unable to look at one single point.
  • Confusion – The person infected with TB meningitis might not recognize the time or place they are in.
  • Abnormal Involuntary Movements – Tremors in the hands and other parts of the body. The person might also experience involuntary, repetitive, brief, irregular movements in the body (chorea). Dystonia or involuntary contractions in the mouth and face such as teeth grinding and difficulty talking might be experienced.

Grade 3 – Almost no level of consciousness with focal neurological symptoms

At this stage, TB meningitis bacteria has gone deep into the brain. Complications such as hydrocephalus or build-up of fluid in the brain and cerebral vasculitis or inflammation in the blood vessel walls of the brain are likely to occur.

  • Seizures – Jerky movements in the body caused by an uncontrolled electric disturbance in the brain.
  • Delirium – Difficulty thinking. This might include poor memory, trouble understanding speech, and difficulty in talking.
  • Coma – A state of prolonged unconscious wherein the person cannot be awakened.
  • Abnormal Posturing – Involuntary extension of the arms and legs.
  • Abnormal Movements – The person might experience tremors, chorea, and or dystonia.

As a person goes through TB meningitis stages, the chances of surviving becomes slimmer and slimmer. This is why TB meningitis needs to be diagnosed as early as possible.

Is It Just a Headache? TB Meningitis Symptoms To Watch Out For

Diagnosing TB meningitis

Doctors will perform a lumbar puncture to know if the person has TB meningitis. A lumbar puncture involves inserting a needle in the lumbar bones to obtain a sample of the cerebrospinal fluid (CSF). Doctors will then analyze the CSF for Mycobacterium tuberculosis.

The patient might also have to go through an MRI and CT Scan for further investigation of signs of TB meningitis.


Treatment for TB meningitis can take up to 6-24 months depending on different factors such as severity, co-infection with HIV, and the patient’s response. Multidrug-resistant tuberculosis might also present complications in treatment.

Doctors may use a combination of antibacterial drugs to kill off the bacteria and lessen any inflammation in the meninges. Use of corticosteroids might also help with treatment, especially for multidrug-resistant bacteria.

A person infected with TB meningitis is at risk of developing the disease again so it might require a lifetime of monitoring once the person has recovered.

Key takeaway

TB meningitis is a severe form of TB infection where the bacteria has entered the bloodstream and reached the brain. TB meningitis goes in three stages of severity. As the disease increases in severity, the less likely a patient will survive. TB meningitis is treatable especially if detected early.

Learn more about Infectious Diseases here.

Hello Health Group does not provide medical advice, diagnosis or treatment.


Treatment of Tuberculous Meningitis and Its Complications in Adults, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5830467/

Accessed February 9, 2021


TREATMENT OF TUBERCULOUS MENINGITIS, https://apps.who.int/iris/bitstream/handle/10665/266095/PMC2553940.pdf?sequence=1&isAllowed=y

Accessed February 9, 2021


Tuberculous meningitis, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4121465/

Accessed February 9, 2021


Meningitis, Tuberculous, https://rarediseases.org/rare-diseases/meningitis-tuberculous/#:~:text=Tuberculous%20Meningitis%20(TBM)%20is%20a,bacterium%20known%20as%20Mycobacterium%20tuberculosis.

Accessed February 9, 2021


Meningitis – tuberculous, https://medlineplus.gov/ency/article/000650.htm

Accessed February 9, 2021


Tuberculous meningitis in children: Clinical management & outcome, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6829784/

Accessed February 9, 2021


Tuberculous meningitis: advances in diagnosis and treatment, https://doi.org/10.1093/bmb/ldv003

Accessed February 9, 2021

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Written by Hazel Caingcoy Updated Apr 16, 2021
Fact Checked by Hello Doctor Medical Panel