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Tuberculous meningitis in children: manifestation of an immune compromised state
1Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi.
Insights
Tuberculous meningitis (TBM) in young children shows a strong cell-mediated immunity (CMI) response, indicated by increased T cells and positive leucocyte migration inhibition tests. However, humoral immunity is weakened, with decreased immunoglobulin levels in TBM patients.
Area of Science:
- Immunology
- Pediatrics
- Infectious Diseases
Background:
- Tuberculous meningitis (TBM) is a severe form of tuberculosis affecting the central nervous system.
- Understanding the immune response in TBM is crucial for diagnosis and treatment.
- Immune status in children with TBM, particularly in the 0-4 year age group, requires detailed investigation.
Purpose of the Study:
- To investigate the cell-mediated and humoral immune status in children aged 0-4 years diagnosed with TBM.
- To compare the immune profiles of TBM patients with age, sex, and nutritional status-matched healthy controls.
- To explore the relationship between cell-mediated immunity (CMI) and humoral immune responses in TBM.
Main Methods:
- Studied 30 children (0-4 years) with TBM and 20 matched controls.
- Assessed cell-mediated immunity through absolute T cell counts, T cell percentages, leucocyte migration inhibition (LMI) tests, and Mantoux tests.
- Evaluated humoral immunity by measuring EAC rosettes and levels of IgA, IgG, and IgM; complement levels were also assessed.
Main Results:
- TBM patients had significantly increased absolute T cell counts and high LMI test positivity (93%).
- A significant difference in LMI index was observed between before and during therapy in TBM patients.
- Humoral response showed decreased levels of IgA, IgG, and IgM, while complement levels remained unchanged compared to controls.
Conclusions:
- Children with TBM exhibit a robust cell-mediated immune response.
- A significant impairment in humoral immune response, characterized by reduced immunoglobulin levels, is observed in TBM.
- The findings suggest an inverse relationship between cell-mediated and humoral immune responses in pediatric tuberculous meningitis.
Abstract:
Thirty children in the age group 0-4 years with tuberculous meningitis (TBM) were investigated for their immune status (cell-mediated and humoral). Twenty age, sex and nutritional status matched children were investigated on the same lines, who served as controls. Absolute T cell counts were significantly increased (3126 +/- 1623) (p < 0.01) in TBM, though T cell percentages were comparable (59.8% in TBM versus 54.44% in controls). Leucocyte migration inhibition (LMI) test positivity was high (93%) in TBM patients. Mean LMI index showed a highly statistically significant difference (p < 0.001) between the 'Before-therapy' (0.62 +/- 0.16) and 'During-therapy' (0.77 +/- 0.23) groups in TBM patients. Mantoux test positivity with 1 TU of PPD was low (53.0%) in TBM in comparison to LMIT positivity. In humoral immune response, quantitative function measured by EAC rosettes was not altered. However, there was a significant decrease in the levels of IgA (79.48 +/- 33.78 IU) (p < 0.01), IgG (115.01 +/- 32.56 IU) (p < 0.01) and IgM (148.50 +/- 51.88 IU) (p < 0.05) in TBM patients. There was no significant difference in the complement levels in the TBM and control groups. The results show a well developed CMI response but a poor humoral response in TBM and represent an inverse relationship between the CMI and humoral responses.