Failure To Diagnose TB Meningitis
If your loved one has died or has been left with severe disabilities because doctors failed to diagnose TB meningitis, you need to talk to a solicitor. The medical staff may have breached their duty of care, meaning you would be entitled to pursue legal action for their failings.
For more information on making a medical negligence compensation claim, please get in touch with our lawyers at Glynns Solicitors.
Pulmonary tuberculosis
Tuberculosis, or 'TB', is a chronic bacterial infection usually caused by the organism Mycobacterium tuberculosis. It typically affects the lungs, which is known as pulmonary TB. This can be highly infectious and normally presents with chronic cough, tiredness and weight loss. It is usually diagnosed with a chest x-ray and sputum culture. In industrialised Western countries, TB has been successfully controlled by routine skin testing of school children and the BCG vaccination.
However, with pulmonary tuberculosis the infection can lie dormant in the lungs and lymph nodes following initial infection. The condition can then become re-activated, giving rise to post-primary or secondary infection. This can cause an allergic tissue reaction with a bumpy and inflamed rash on the skin (called granuloma).
If there is a delay in treating pulmonary tuberculosis, the bacteria may spread to the bloodstream and produce multiple seeds of further infection in other organs known as military TB. This ordinarily affects the liver, spleen, ocular choroid, bone and the central nervous system (CNS).
Tuberculous meningitis
The central nervous system comprises of the brain and the spinal cord. The most common presentation of a TB infection involving the CNS is tuberculous meningitis. It is the most serious of all forms of TB, and can cause mass lesions known as tuberculomata or tuberculous abscesses to occur in the brain and spinal cord.
The speed with which TB meningitis develops is much slower than bacterial meningitis. In a typical case, TB meningitis is preceded by a period of two to eight weeks of non-specific symptoms, including tiredness, loss of appetite, fever, muscle pain and headache. The headaches are initially intermittent, and eventually worsen and become continuous.
Complications of TB meningitis
In TB meningitis, the bacteria enter the cerebro-spinal fluid (CSF), which surrounds the brain and spinal cord. It is thought this happens via a rupture of one of the lesions (tuberculomata) on the brain or spinal cord. Once the bacteria have entered the cerebro-spinal fluid, a mass of fluid will develop at the base of the brain. This is called basal meningitis.
Basal meningitis is extremely dangerous as it leads to the formation of adhesions, preventing the normal flow of fluid around the brain. Life-threatening complications can then arise, such as obstructive hydrocephalus, obliterative vasculitis and encephalitis.
Progression of TB meningitis
With the progression of TB meningitis, the patient develops increasing irritability, vomiting, confusion and seizures. Abnormal physical signs will be visible as a result of the lesions on the central nervous system and/or the inflammation of blood vessels. These abnormal physical signs can include movement disorders, with paralysis on one side of the body.
As complications such as obstructive hydrocephalus and rising intracranial pressure develop, the patient will begin to lose consciousness. Intracranial pressure (ICP) is the pressure within the skull. Excessive rises in ICP can result in serious brain damage, especially if they occur rapidly.
Diagnosis of TB meningitis
The most important considerations in the management of any patient with suspected bacterial meningitis are determining the cause, and administering immediate antimicrobial therapy.
If possible, CSF and blood specimens for culture should be obtained prior to treatment commencing. CSF can be drained off during a lumbar puncture. These tests should be analysed to check for abnormalities in cell count, and protein and glucose and concentrations. A CT scan of the brain will also reveal whether there are any space-occupying lesions which are increasing intracranial pressure.
Proof of the diagnosis depends upon the detection of acid-fast bacteria within the cerebro-spinal fluid. Nevertheless, the results can take between three and eight weeks to confirm, meaning treatment has to be started before a diagnosis is verified.
Recovering from TB meningitis
The prognosis is normally excellent in cases of TB meningitis recognised early and sensitive to standard chemotherapy. For these reasons, a high degree of clinical suspicion is required to make the diagnosis, and treatment may often have to be started before a firm diagnosis is obtained to avoid harm.
Delay in diagnosis and treatment
In contrast to the more common forms of infectious bacterial meningitis, the early diagnosis of TB meningitis can be more difficult for various reasons: the disease is now rare, the symptoms are usually non-specific and neurological signs absent. Unless there is already established focal neuropathy, cranial imaging may show only non-specific changes of hydrocephalus or meningeal enhancement.
This can cause problems as emergency surgery is almost always necessary to reduce pressure within the brain. Without speedy neurosurgical intervention, this rapid sequence of events can ultimately result in irreversible brainstem compression and death. This outlook is therefore dismal if the condition goes unrecognised and/or untreated.
If a patient does survive, it is likely that he/she will have permanent neurological damage, including a degree of paralysis, seizures and cognitive impairment.
Failure to diagnose and treat TB meningitis
When a patient presents with symptoms indicative of TB meningitis, medical practitioners should act with caution and take immediate steps to verify whether or not this diagnosis is correct. A lumbar puncture should be carried out and treatment started without delay. A CT scan should also be arranged.
If medical practitioners fail to act with the appropriate urgency or competence, the consequences will be devastating for the patient and their family. The delay in treatment could allow severe brain damage to develop, resulting in a pessimistic outlook.
Free legal advice
If you have any reason to believe that medical professionals failed to manage your loved one's TB meningitis properly, please get in touch with us today. We will help you understand what options available, suggesting whether there has been a case of medical negligence.
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