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Central nervous system tuberculosis in children
1Department of Neurology, University of Miami School of Medicine, FL 33101.
Insights
Childhood central nervous system tuberculosis is rising in the US. Early diagnosis using cranial computed tomography and cerebrospinal fluid analysis is crucial for prompt antituberculous therapy.
Area of Science:
- Neurology
- Infectious Diseases
- Pediatrics
Background:
- Tuberculosis incidence is increasing across all age groups in the United States.
- Central nervous system (CNS) involvement occurs in 5% of all tuberculosis patients.
- Childhood CNS tuberculosis is a rare but serious condition, often leading to delayed diagnosis due to low awareness.
Observation:
- A study reviewed childhood CNS tuberculosis cases between 1979 and 1989, including literature review for patients up to 14 years of age.
- Delayed diagnosis is a significant challenge due to the infrequent reporting of such cases in the US.
- Cranial computed tomography (CT) within one week of symptom onset can identify key indicators.
Findings:
- Radiographic findings on cranial CT may include basilar enhancement, hydrocephalus, or infarction.
- Cerebrospinal fluid (CSF) analysis reveals findings atypical for common bacterial infections.
- Combined CT and CSF findings support the early initiation of antituberculous therapy.
Implications:
- Prompt diagnosis and treatment are vital to improve outcomes for children with CNS tuberculosis.
- Increased awareness among healthcare providers is necessary to reduce diagnostic delays.
- Antituberculous therapy, guided by early diagnostic indicators, is essential for managing this condition.
Abstract:
The incidence of tuberculosis in the United States is increasing in all age groups; 5% of all of these patients have central nervous system involvement. We studied childhood central nervous system tuberculosis between 1979 and 1989 and reviewed the literature for patients up to 14 years of age. The small number of patients reported in this country results in delayed diagnoses because of reduced awareness. Cranial computed tomography within 1 week of initial symptoms may reveal basilar enhancement, hydrocephalus, or infarction. When combined with cerebrospinal fluid findings atypical for common bacterial infection, these radiographic findings support the prompt initiation of antituberculous therapy. Prophylactic considerations are also discussed.