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[Cerebromeningeal tuberculosis: 15 pediatric cases]
I Ould Khalifa1, H Selmi, B Tabaeki
1Service de pédiatrie, CHU Farhat Hached, Sousse.
Insights
Cerebromeningeal tuberculosis is difficult to diagnose, with delayed diagnosis and low CSF glucose predicting poor outcomes in children. Early detection is crucial for improving survival and reducing neurological deficits.
Area of Science:
- Neurology
- Infectious Diseases
- Pediatrics
Background:
- Cerebromeningeal tuberculosis presents diagnostic challenges, particularly in pediatric populations.
- Tuberculosis affecting the brain and meninges requires specific diagnostic and management strategies.
Observation:
- A study of 15 pediatric patients (mean age 6 years) with cerebromeningeal tuberculosis (13 meningitis, 2 tuberculoma) was conducted.
- Initial diagnosis was challenging, with common signs including meningism, altered mental state, and neurological deficits.
- Cerebrospinal fluid (CSF) analysis revealed elevated leukocytes (>20/mm3), high protein (>1 g/l in 66%), and low glucose (<2.2 mmol/l in 80%). BK was isolated in 7 patients.
Findings:
- 33% of patients (5 out of 15) died during the study period.
- Major neurological sequelae were observed in 5 patients, while 5 patients achieved complete recovery.
- Factors associated with fatal outcomes and permanent sequelae included delayed diagnosis, altered consciousness, hypotrophy, and low CSF glucose levels.
Implications:
- Emphasizes the need for heightened clinical suspicion and prompt diagnostic workup for cerebromeningeal tuberculosis in children.
- Highlights the prognostic significance of early clinical signs and CSF parameters.
- Suggests that timely intervention based on these factors may improve patient outcomes and reduce long-term neurological damage.
Abstract:
Fifteen patients (9 girls and 6 boys) with different forms of cerebromeningeal tuberculosis (meningitis: 13 cases, tuberculoma: 2 cases) was reported. Their mean age was 6 years (4 months to 14 years). The initial diagnosis was difficult. Half patients had meningism, abnormal mental state and defects signs. The cerebrospinal fluid (CSF) leukocyte count was > 20/mm3, protein > 1 g/l (66%) and glucose < 2.2 mmol/l (80%). BK was isolated in 7 patients. Five patients (33%) died. Major neurological sequelae developed in 5 patients and 5 patients completely recovered. Factors predicting fatal outcome and permanent sequelae were: diagnosis delay, altered level of consciousness, hypotrophy and low glucose level in CSF.