Tuberculous Meningitis in Pediatric Patients: Diagnosis, Clinical Course, and Outcomes in the Modern Era

Tuberculous meningitis (TBM) is a critically severe form of extrapulmonary tuberculosis in pediatric patients, presenting a significant diagnostic challenge during the early stages of clinical manifestation. Delayed recognition of meningeal tuberculous inflammation leads to the involvement of the brain parenchyma (encephalitis) and may result in irreversible neurological sequelae.

To evaluate the clinical features, the spectrum of complications, and the acute outcomes of tuberculous meningitis in pediatric patients managed at a tertiary reference center.

A retrospective observational study of 21 medical records was conducted for pediatric patients aged 3 months to 17 years (mean age: 6.7 ± 5.8 years) with a confirmed TBM diagnosis. The study included pediatric patients treated in the inpatient pediatric department (n = 6) or evaluated through the national telemedicine consultation system (n = 15) between 2017 and 2025.

A history of contact with a tuberculosis patient was established in 62% (13/21) of cases. At initial presentation, fever was recorded in 67% (14/21) of patients, nausea and/or vomiting in 52% (11/21), headache in 33% (7/21), and meningeal signs in 38% (8/21). The majority of patients (52%, 11/21) had not received BCG vaccination. Mycobacterium tuberculosis (MTB) was microbiologically confirmed in 19 patients (90.5%). MTB DNA was detected in the cerebrospinal fluid (CSF) in 71.4% of all patients (15/21; 78.9% of confirmed cases). Drug resistance (DR) was confirmed in 47.4% of confirmed patients (9/19; 42.9% of the total cohort), comprising MDR (15.8%, 3/19), pre-XDR (15.8%, 3/19), and XDR (15.8%, 3/19) strains. Neurological complications included hydrocephalus in 47.6% (10/21), motor deficits in 38.1% (8/21), and epileptic syndrome in 19.0% (4/21). In-hospital mortality was 0%, while four patients (19.0%) with critically severe irreversible brain damage were transitioned to palliative care.

In this tertiary pediatric cohort, TBM presented predominantly as a severe form of meningoencephalitis with extensive brain parenchymal involvement and high rates of systemic dissemination, frequently complicated by hydrocephalus, motor deficits, and seizures. Epileptic seizures showed an exploratory statistical trend toward an association with unfavorable neurological outcomes (p = 0.052). These findings underscore the urgent need to optimize early diagnostic strategies within general healthcare networks.