Tubercular meningitis–A tale of 50 years

• DOI: 10.1007/s13312-016-0864-6
• Publication Date: 2016-05-17T08:44:48Z
• Authors: Preeti Singh; Anju Seth
• Keywords: 0301 basic medicine; 0303 health sciences; Infant, Newborn; India; Infant; History, 20th Century; History, 21st Century; 3. Good health; 03 medical and health sciences; Child, Preschool; Tuberculosis, Meningeal; Practice Guidelines as Topic; Humans; Child

Whyth in 1768 for his treatise ‘Dropsy in the brain’ [2]. The patho-physiology of TBM was unravelled by Arnold Rich and McCordock in 1933 [3]. Before the mid-20th century, childhood TB was uniformly fatal. The introduction of isoniazid in early 1950’s revolutionized the treatment of TB. For nearly two decades, the standard treatment comprised of combination of isoniazid and streptomycin, following which rifampicin was introduced. Still, the mortality was very high, and significant proportions were left with physical and mental disabilities due to delay in treatment initiation and poor compliance. To strengthen the fight against TB, the Government of India launched “District Tuberculosis Control Programme” in 1962 which focussed on prevention, control and management of the disease in both urban as well as rural areas. At the time of publication of this article [1], there existed wide disparity in the reported incidence (0.5-13%) of TBM in India, and its true situation was difficult to determine because of diagnostic uncertainties and poor case notification. In most cases, the diagnosis was presumptive, based on clinical suspicion and circumstantial evidence as bacteriological confirmation was often not possible.