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Tuberculous meningitis in children: clinical features and outcome in 40 cases
H Paganini1, F Gonzalez, C Santander
1Department of Infectious Diseases, Hospital de, Pediatría Professor Dr Juan P. Garrahan, Buenos Aires, Argentina.
Insights
Tuberculous meningitis in children is serious, with 45% fully recovering and 7% fatal. Early diagnosis and treatment are crucial for better outcomes in pediatric tuberculosis.
Area of Science:
- Pediatrics
- Infectious Diseases
- Neurology
Background:
- Tuberculous meningitis (TBM) poses a significant threat to pediatric populations.
- Understanding TBM epidemiology, clinical presentation, and outcomes is vital for effective management.
Purpose of the Study:
- To evaluate the epidemiology, clinical features, and outcomes of tuberculous meningitis in children.
- To identify risk factors associated with TBM to guide early intervention.
Main Methods:
- A retrospective review of 40 pediatric TBM cases diagnosed between January 1989 and December 1995.
- Analysis included patient demographics, clinical staging, diagnostic tests (PPD, Mycobacterium tuberculosis recovery), imaging (CT scans for hydrocephalus), and treatment outcomes.
Main Results:
- TBM represented 10% of all pediatric tuberculosis cases. Mean age was 46 months, with 45% in Stage I, 40% in Stage II, and 15% in Stage III.
- Hydrocephalus was present in 78% of cases. Full recovery was observed in 45%, while 18%, 8%, and 22% experienced mild, moderate, and severe neurological sequelae, respectively. Mortality was 7%.
- Seizures and the absence of extrameningeal foci were identified as significant risk factors (RR 15.6 and 4.95, respectively).
Conclusions:
- Tuberculous meningitis in children has a substantial impact, with significant rates of sequelae and mortality.
- Early diagnosis and prompt treatment are essential to improve outcomes and reduce the long-term burden of TBM in pediatric patients.
Abstract:
In order to assess the epidemiology, clinical features and outcome of tuberculous meningitis, a retrospective review of patients was conducted between January 1989 and December 1995. Forty cases (representing 10%, of all paediatric patients with tuberculosis) were included. Mean age was 46 months (range 1-165 months). Eighteen (45%) children were classified as stage I (non-specific febrile illness without neurological signs), 16 (40%) as stage II (neurological signs without marked changes in sensorium) and 6 (15%) as stage III (major neurological signs with sensorial changes and/or coma). Twenty-seven (67%) patients had received BCG vaccination and 14 (35%) displayed an induration zone higher than 10 mm after a 2-TU PPD test. Mycobacterium tuberculosis was recovered from 24 (61%) patients. Hydrocephalus was demonstrated by cranial computed tomography in 31 (78%) children. Overall, 18 (45%) children had a full recovery. Mild, moderate and severe neurological sequelae were shown by 7 (18%), 3 (8%) and 9 (22%) of the patients, respectively. Three fatal cases (7%) were observed. The presence of seizures (RR 15.6, 2.02-119.1) and absence of extrameningeal foci (RR 4.95, 1.10-22.1) were identified as risk factors by multivariate analysis. These findings emphasize the need quickly to diagnose tuberculosis in children in order to give appropriate and early treatment.