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[Clinical course, treatment and outcome of tuberculous meningitis in children]
Insights
Tuberculous meningitis in children can be effectively treated, with 86.1% achieving cure. However, late diagnosis significantly increases the risk of fatal outcomes, highlighting the need for timely intervention in pediatric tuberculous meningitis.
Area of Science:
- Pediatrics
- Infectious Diseases
- Neurology
Background:
- Tuberculous meningitis (TBM) is a severe form of tuberculosis affecting the central nervous system.
- Pediatric TBM presents unique challenges in diagnosis and management.
- Understanding the clinical course and outcomes is crucial for improving patient care.
Purpose of the Study:
- To evaluate the clinical characteristics, treatment efficacy, and outcomes of tuberculous meningitis in a cohort of children.
- To identify factors associated with disease progression and mortality.
Main Methods:
- Follow-up study of 108 children aged 6 months to 15 years diagnosed with tuberculous meningitis.
- Analysis of clinical presentation, including meningitis form (basilar vs. meningo-encephalitic) and associated pulmonary changes.
- Assessment of diagnostic delays, superinfections, and treatment outcomes (cure, residual changes, fatal outcomes).
Main Results:
- Basilar meningitis was diagnosed in 70.4% and meningo-encephalitic in 29.6% of cases.
- Pulmonary changes were present in most children; 25.9% had an acute disease course.
- Superinfection occurred in 64%, and late diagnosis/hospitalization in 31.5% of cases.
- Effective treatment led to cure in 86.1%, with 13.9% experiencing significant residual changes.
- Late diagnosis was associated with a 13.9% fatal outcome rate.
Conclusions:
- Current treatment for pediatric tuberculous meningitis is effective, achieving high cure rates.
- Timely diagnosis and hospitalization are critical to prevent severe sequelae and reduce mortality.
- Significant residual neurological deficits can occur, particularly in meningo-encephalitic forms.
Abstract:
Data are given on the follow-up of 108 children between the ages of 6 months and 15 years who had tuberculous meningitis. A basilar form of meningitis was diagnosed in 70.4% of the children and meningo-encephalitic form in 29.6%. In most of the children meningitis developed in the presence of specific changes in the lungs; the course was typical in 74.1% and acute in 25.9%. Superinfection was seen in 64% of the children, late diagnosis and untimely hospitalization of children were noted in 31.5%. A clear relationship was revealed between disappearance of clinical signs and liquor cleansing and hospitalization terms. Treatment currently applied is effective. Cure was seen in 86.1% of the cases in the presence of significant residual changes (in meningoencephalitis) in 13.9%. The disease had a fatal outcome in 13.9% of the cases of late diagnosis.