Late onset hydrocephalus in children with tuberculous meningitis

Area of Science:

• Neurology
• Infectious Diseases
• Pediatrics

Background:

• Tuberculous meningitis (TBM) commonly leads to hydrocephalus.
• Hydrocephalus typically presents within 4-6 weeks of TBM onset.

Observation:

• Three patients with multi-drug resistant tuberculosis (MDR-TB) developed hydrocephalus later in their disease course.
• One patient experienced worsening hydrocephalus despite a patent ventricular peritoneal shunt, responding to acetazolamide.
• Two other patients required ventricular peritoneal shunt insertion after 14 months of treatment.

Findings:

• Hydrocephalus can manifest as a late-onset complication in MDR-TB patients.
• Treatment with second-line anti-tuberculous therapy (ATT) did not prevent late-onset hydrocephalus in these cases.
• Hydrocephalus management varied, including acetazolamide and shunt insertion.

Implications:

• Clinicians should consider late-onset hydrocephalus in MDR-TB patients, necessitating vigilant neurological monitoring.
• This highlights the complex interplay between MDR-TB, its treatment, and neurological complications.
• Further research into the mechanisms and optimal management of late-onset hydrocephalus in MDR-TB is warranted.