Issues arising from two related cases of childhood tuberculous meningitis

Two cases of childhood meningitis occurred in the same school within two weeks. The cases were cousins. The first case died and the aetiology was confirmed as tuberculous following a gene probe of a culture from the meningeal tissues at postmortem. The second case, with similar life threatening clinical features compatible with tuberculous meningitis, recovered. Seventy-seven contacts of the two cases among the immediate and extended families were screened. The adult sources of the infection were found to be two aunts of the second case, who were nurses working in the same nursing home. A further 73 contacts of the adult cases were identified. A total of eight close contacts to the aunts were given chemoprophylaxis and three were treated for tuberculosis. Contact tracing was also undertaken in the nursing home but no further cases were identified. These two cases highlight the difficulties in making a rapid diagnosis in tuberculous meningitis, the difficulties in handling media and public concern with limited information, and deciding on the appropriate level of contact tracing in special circumstances.