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Published on: February 16, 2020
Diagnosis of central nervous system tuberculosis in pediatric patients
María I Urteneche1, Norma E González2, Eugenia Ginestet2
1Central Laboratory Division, Microbiology Section; Hospital General de Niños Pedro de Elizalde, City of Buenos Aires, Argentina.
Insights
Central nervous system tuberculosis (CNS TB) in children often presents with neurological symptoms and requires prompt diagnosis. Molecular biology offers faster confirmation than traditional culture methods for Mycobacterium tuberculosis.
Area of Science:
- Pediatrics
- Infectious Diseases
- Neurology
Background:
- Central nervous system tuberculosis (CNS TB) is a severe Mycobacterium tuberculosis (Mtb) infection with high mortality and neurological sequelae if diagnosed late.
- Early and accurate diagnosis of pediatric CNS TB is critical to improve patient outcomes.
Purpose of the Study:
- To characterize CNS TB cases in a pediatric hospital.
- To evaluate the diagnostic elements and their sensitivities for CNS TB in children.
- To compare the diagnostic performance of different microbiological techniques.
Main Methods:
- An observational, retrospective study of pediatric CNS TB cases diagnosed between January 2013 and February 2022.
- Review of medical and laboratory records, including epidemiological, clinical, imaging, cerebrospinal fluid (CSF) analysis, and mycobacterial bacteriology.
- Assessment of sensitivities for neurological symptoms, CSF findings, and microbiological tests.
Main Results:
- Twenty-six pediatric CNS TB cases were identified; 96% presented with neurological symptoms.
- Meningeal symptoms (92%) and fever (73%) were highly sensitive indicators; hydrocephalus was more common in children under 5.
- CSF analysis showed high sensitivity for clear aspect (92%) and elevated proteins (50%); molecular biology (61% sensitivity) provided faster confirmation than culture (75% sensitivity).
Conclusions:
- Neurological symptoms, compatible CSF findings, epidemiological links, and pulmonary involvement are sensitive indicators for pediatric CNS TB.
- Molecular biology significantly reduces detection time for microbiological confirmation compared to culture.
- Early diagnosis and prompt microbiological confirmation are crucial for managing pediatric CNS TB effectively.
Abstract:
Introduction. Central nervous system tuberculosis (CNS TB) represents a severe form of Mycobacterium tuberculosis (Mtb) infection. Late diagnosis is associated with increased mortality and neurological sequelae. Objective. To characterize CNS TB diagnosed in a pediatric hospital and describe the diagnostic elements, estimating their sensitivity. Materials and methods. An observational, retrospective study included CNS TB cases diagnosed between January 2013 and February 2022. Medical and laboratory records were reviewed, and epidemiological, clinical, imaging, cerebrospinal fluid cytochemical, and bacteriological data for mycobacteria were recorded. Results. Twenty-six cases of CNS TB were diagnosed, and 22 had pulmonary involvement. Ninety-six percent had neurological symptoms, with sensitivities of 46% for focal symptoms, 92% for meningeal symptoms, and 73% for the presence of fever. Hydrocephalus was more frequently observed in children under 5 years of age. In the study of cerebrospinal fluid, the clear aspect (92%) and proteins upon 1 g/L (50%) showed higher sensitivity, with higher levels in children under 5 years of age. As for microbiological results, smear microscopy was negative in all cases, while molecular biology and culture showed 61% and 75% sensitivity, respectively. The detection time was significantly shorter for molecular biology than for culture (p < 0.01). Conclusions. The presence of neurological symptoms, compatible cerebrospinal fluid, epidemiological link, and pulmonary involvement showed high sensitivity. Molecular biology allowed for earlier microbiological confirmation.
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