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[Acute tuberculous meningitis in children. A report on 4 cases (author's transl)]
Insights
Tuberculous meningitis in children can lead to severe outcomes, including death and neurological deficits. Early diagnosis and appropriate treatment, alongside vaccination and tuberculin monitoring, are crucial for managing this serious infection.
Area of Science:
- Pediatric Infectious Diseases
- Neurology
- Public Health
Background:
- Tuberculous meningitis (TBM) remains a significant global health challenge, particularly in pediatric populations.
- Effective management requires a thorough understanding of its diagnostic and clinical manifestations.
Observation:
- A study involving four children with acute TBM highlighted the severe potential consequences of the disease.
- Outcomes included mortality in one case and severe neurological sequelae in two others, underscoring disease severity.
Findings:
- Treatment protocols involve a combination of anti-tuberculosis drugs like isoniazid (INH), rifampicin, and ethambutol.
- Intravenous or oral administration routes are utilized based on patient condition, with intrathecal rifamycine SV for acute forms.
- Corticosteroids are indicated for intracranial hypertension with cerebral edema, potentially requiring surgical decompression.
Implications:
- The continued notification of TBM cases justifies the importance of early Bacillus Calmette-Guérin (BCG) vaccination.
- Regular monitoring of tuberculin allergic reactions is essential for early detection and intervention strategies.
- Prompt diagnosis and comprehensive treatment are vital to mitigate the severe neurological impact of TBM in children.
Abstract:
Four children were treated for acute tuberculous meningitis. One child died and 2 others were left with severe neurological sequellae. The diagnostic and clinical signs of tuberculous meningitis are reviewed. Treatment includes the administration of an association of INH-rifampicine and ethambutol orally, or INH-ethambutol-ethionamide intravenously when oral administration is impossible. Intrathecal injections of rifamycine SV can be given for acute forms. Corticoids have only one indication: intracranial hypertension with cerebral edema, which requires surgical decompression if no improvement is obtained. The fact that cases of tuberculous meningitis are still notified, is a justification for early BCG vaccination and regular control of the tuberculin allergic reaction.