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[Tuberculous meningitis in children. Study of 34 cases (author's transl)]
Insights
Early diagnosis and prompt triple-drug therapy are crucial for treating tuberculous meningitis in children. This approach significantly impacts outcomes, reducing mortality and long-term sequelae in pediatric cases.
Area of Science:
- Pediatric Infectious Diseases
- Neurology
- Microbiology
Context:
- Tuberculous meningitis (TBM) poses a significant threat to children globally.
- Diagnosis is often delayed, leading to severe neurological deficits and mortality.
- Limited data exists on treatment outcomes in unvaccinated pediatric populations.
Purpose:
- To review clinical characteristics, diagnostic findings, and treatment outcomes of 34 pediatric tuberculous meningitis cases.
- To evaluate the efficacy of triple-drug therapy (streptomycin, rifampicin, isoniazid) and corticosteroid use.
- To highlight the importance of early diagnosis and its relation to patient evolution.
Summary:
- The study reviewed 34 pediatric TBM cases (6 months-8 years), with peak incidence in the 0.5-2 year age group.
- Most patients presented with advanced disease (Stage II/III), and none had BCG vaccination; 29.4% had a family history of TB.
- Diagnostic yield was low for "Mycobacterium tuberculosis" in CSF (20.5%) but higher for Mantoux (70.5%) and chest X-ray (50%).
- Triple-drug therapy (21 months avg.) and corticosteroids were administered. Frequent complications included seizures, hydrocephalus, and hepatotoxicity.
- Mortality was 14%, with 55% of survivors experiencing sequelae, underscoring the need for early diagnosis.
Impact:
- Findings emphasize the critical role of early diagnosis in improving outcomes for pediatric tuberculous meningitis.
- The study informs treatment protocols and highlights the challenges in diagnosing TBM in children.
- Results contribute to understanding the long-term sequelae and mortality associated with delayed TBM diagnosis and treatment.
Abstract:
Thirty four cases of tuberculous meningitis in children of 6 months to 8 years of age are reviewed. Maximum frequency (44% of the cases) correspond to 0.5 to 2 year age group. In 55.8% of the cases symptoms appeared less than 20 days before admission to hospital. On admission 24% of the cases were in stage I, 64.7% in stage II and 11.7% in stage III according to the criteria of the Medical Research Council. None of the patients had been vaccinated with BCG. a family history of active tuberculosis was shown in 29.4% of the cases. "Mycobacterium tuberculosis" was isolated from spinal fluid in only 20.5% of the cases. A positive Mantoux was found in 70.5% and 50% showed a pathological chest X-ray film. A triple-drug therapy was instituted immediately after diagnosis. First choice drugs were streptomycin, rifampicin and isoniazid. Average length of treatment was 21 months. Corticosteroids were given to 17 children. Most frequent complications were convulsions, hydrocephalus, ophthalmoplegia, hyponatremia and hepatotoxicity due to rifampicin. Mortality rate was 14% and 55% of the survivors developed sequelae. Relations between precocity of diagnosis, therapeutic protocol and evolution are discussed. Importance of early diagnosis is stressed.