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Tuberculous meningitis in infancy
Yu-Ren Tung1, Ming-Chi Lai, Chun-Chung Lui
1Department of Pediatrics, Chang Gung Memorial Hospital, Niao Sung, Kaohsiung County, Taiwan.
Insights
Diagnosing tuberculous meningitis in infants is challenging due to non-specific symptoms. Prompt antituberculosis therapy is crucial for young infants presenting with meningitis, hyponatremia, and hydrocephalus.
Area of Science:
- Pediatrics
- Infectious Diseases
- Neurology
Background:
- Tuberculous meningitis (TBM) diagnosis is difficult in infants due to non-specific symptoms.
- Limited literature exists on TBM in infants under 1 year old.
Purpose of the Study:
- To review clinical features and laboratory findings of TBM in infants younger than 1 year.
- To identify key indicators for early TBM diagnosis in this age group.
Main Methods:
- Retrospective review of seven infants diagnosed with TBM over 15 years.
- Analysis of clinical presentation, laboratory results (purified protein derivative skin test, cerebrospinal fluid analysis), and brain sonography findings.
Main Results:
- All infants presented with fever, cough, and altered consciousness.
- Common findings included bulging anterior fontanel, seizures, hyponatremia, and hydrocephalus.
- Cerebrospinal fluid analysis often showed cell counts <500 cells/mm³ with lymphocytic predominance.
Conclusions:
- Prompt antituberculosis therapy is recommended for infants with suspected meningitis, hyponatremia, and hydrocephalus.
- Cerebrospinal fluid findings (low cell count, lymphocytic predominance) are critical indicators.
- Brain sonography is essential for detecting hydrocephalus in suspected TBM cases.
Abstract:
The lack of specific symptoms and signs in patients with tuberculous meningitis makes early diagnosis difficult. To our knowledge, there has been no report in the literature focusing on tuberculous meningitis patients younger than 1 year of age. In this report, we reviewed the clinical features and laboratory findings of seven infants with tuberculous meningitis encountered during a 15-year period. All patients had fever, cough, and alternation of consciousness at presentation. Five patients had bulging anterior fontanel, and five had generalized tonic-clonic seizures. The purified protein derivative skin test was positive in six patients. Six patients had hyponatremia. All seven patients had abnormal cerebrospinal fluid findings, and six of them demonstrated cell counts less than 500 cells/mm(3) with lymphocytic predominance. Brain sonography examination revealed hydrocephalus in all seven patients. Therefore we conclude that antituberculosis therapy should be promptly initiated in any young infant with a clinical impression of meningitis in the context of cerebrospinal fluid white cell count of less than 500 cells/mm(3) and lymphocytic predominance, hyponatremia, and hydrocephalus.