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Tuberculous meningitis in children during the isoniazid era
Insights
Tuberculous meningitis in children treated with isoniazid since 1952 resulted in significant long-term neurologic and social disabilities for survivors. Public health measures and chemoprophylaxis are crucial for disease elimination.
Area of Science:
- Pediatrics
- Infectious Diseases
- Neurology
Background:
- Tuberculous meningitis (TBM) remains a significant cause of childhood mortality and morbidity.
- The introduction of isoniazid in 1952 aimed to improve TBM treatment outcomes.
Observation:
- A review of 59 pediatric cases of TBM at Charity Hospital, New Orleans, post-isoniazid introduction.
- Analysis of in-hospital mortality, clinical recovery rates, and long-term sequelae in survivors.
Findings:
- 14 out of 59 children died during hospitalization.
- 21 children achieved complete or near-complete clinical recovery at discharge.
- A significant proportion of long-term survivors (21 assessed) experienced notable neurologic and social disabilities.
Implications:
- Despite advances in therapy, TBM continues to pose long-term challenges for pediatric survivors.
- Understanding transmission dynamics, particularly from adult sources within households, is vital.
- Emphasizes the critical role of chemoprophylaxis and robust public health strategies in TBM prevention and control.
Abstract:
Fifty-nine cases of tuberculous meningitis in children seen at the Charity Hospital at New Orleans since the addition of isoniazid to the therapy in 1952 are reviewed. Fourteen of the children died during hopsitalization. At discharge 21 children had complete or nearly complete clinical recovery. Follow-up of 21 available long-term survivors revealed a significant number with neurologic and social disabilities. The endemicity of tuberculous infections in the households of the children and factors responsible for transmission of tubercle bacilli from an adult source are reported. The importance of chemoprophylaxis and public health measures in eliminating this disease are stressed.