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Clinical and diagnostic features of central nervous system tuberculosis in Indian children - a descriptive study
Bella Devaleenal Daniel1, Elilarasi Selladurai2, Sarath Balaji2
1ICMR - National Institute for Research in Tuberculosis, No 1, Mayor Satyamoorthy Road, Chetpet, Chennai 600031, India.
Insights
Pediatric tuberculous meningitis (TBM) presents unique diagnostic challenges, with younger children often experiencing severe forms. Early identification and comprehensive care are crucial for managing central nervous system (CNS) TB in children.
Area of Science:
- Neurology
- Infectious Diseases
- Pediatrics
Background:
- Tuberculous meningitis (TBM) poses diagnostic difficulties in children due to atypical clinical presentations.
- Central nervous system (CNS) tuberculosis encompasses both TBM and tuberculoma, requiring distinct diagnostic considerations.
Purpose of the Study:
- To characterize the baseline features of children diagnosed with CNS TB, including TBM and tuberculoma.
- To identify key clinical, laboratory, and neuroimaging findings associated with pediatric TBM.
Main Methods:
- A retrospective descriptive study analyzed data from children under 12 years with neurological symptoms.
- Diagnostic evaluations included clinical assessment, laboratory tests, cerebrospinal fluid analysis, and neuroimaging (MRI, CT brain).
Main Results:
- Of 600 children evaluated, 61 (10%) had CNS TB (47 TBM, 14 tuberculoma).
- Neuroimaging revealed TBM-suggestive abnormalities in 76% (MRI) and 77% (CT).
- Cerebrospinal fluid analysis showed abnormalities in white blood cell count (56%), protein (49%), and glucose (47%).
Conclusions:
- Younger children with TBM tend to present with more severe disease.
- Diagnostic confirmation may not always be achievable, necessitating a comprehensive clinical approach.
- Management should address complications like hydrocephalus and strokes.
Background:
Children with tuberculous meningitis (TBM) present with diagnostic challenges as they often have atypical clinical features.
Objective:
To describe the baseline characteristic features of children diagnosed with central nervous system (CNS) TB (TBM and tuberculoma).
Design:
Retrospective descriptive study.
Methods:
Children less than 12 years presenting with neurological signs and symptoms were assessed for a therapeutic TBM trial eligibility. The results of their clinical, laboratory, neuroimaging, cerebrospinal fluid evaluations were analysed for TBM diagnosis.
Results:
Of 600 children evaluated, 61(10%) had CNS tuberculosis; TBM 47, tuberculoma 14. 20(33%) had definite TBM. Mean age of children with TBM was 5 ± 3.4 years. Of 47, 13(28%), 21(45%) and 13(28%) had grade I, II, and III disease respectively. Abnormalities suggestive of TBM in MRI and computed tomography brain were observed in 76% (26/34) and 77% (24/31) respectively. Abnormal cerebrospinal fluid white blood cell count, protein and glucose were observed in 56% (24/43), 49% (22/45), 47% (21/45) respectively. Among 41 patients with TBM followed up until discharge, five died.
Conclusion:
Younger children with TBM have severe forms. Confirmatory results may not be available in all. A holistic approach to care including addressing complications of hydrocephalus and strokes is needed.
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