[Tuberculous meningitis in children]

Area of Science:

• Pediatrics
• Neurology
• Infectious Diseases

Context:

• Tuberculous meningitis (TBM) is a rare but severe form of extrapulmonary tuberculosis.
• It predominantly affects children, often in the absence of adequate tuberculosis prophylaxis.
• Understanding TBM's clinical presentation and outcomes is crucial for early diagnosis and management.

Purpose:

• To describe the clinical characteristics, course, and outcomes of tuberculous meningitis in children.
• To identify patterns of disease presentation, including localization and complications.
• To assess the long-term neurological sequelae and mortality associated with TBM in pediatric patients.

Summary:

• Tuberculous meningitis in children frequently presents with a gradual onset, dominated by infectious-toxic symptoms.
• Basal meningitis with cranial nerve involvement occurred in 59% of cases, while 31.8% showed diffuse meningoencephalitis.
• A significant proportion (63%) of TBM cases were progressive, undetected, and untreated, leading to 18% mortality and 9% neurological impairment at five years.

Impact:

• Highlights the critical need for improved tuberculosis prophylaxis and early detection strategies in children.
• Emphasizes the severe neurological sequelae and high mortality rate associated with delayed or missed TBM diagnosis.
• Informs clinical practice regarding the recognition of subtle TBM presentations and the importance of prompt treatment.