Central nervous system tuberculosis in infants and children

Area of Science:

• Neurology
• Infectious Diseases
• Pediatrics

Background:

• Tuberculous meningitis (TBM) is a severe form of extrapulmonary tuberculosis affecting the central nervous system.
• Early diagnosis and treatment are crucial to prevent neurological sequelae and mortality in pediatric patients.

Purpose of the Study:

• To review the clinical presentation, diagnostic findings, and outcomes of tuberculous meningitis and tuberculoma in pediatric patients.
• To identify key indicators for early diagnosis and management of TBM in children.

Main Methods:

• Retrospective review of hospital records for 16 pediatric patients diagnosed with tuberculous meningitis or tuberculoma over a 10-year period.
• Analysis of clinical symptoms, neurological examination findings, cerebrospinal fluid (CSF) analysis, and neuroimaging (CT scans).
• Correlation of diagnostic findings with treatment initiation and patient outcomes.

Main Results:

• Common symptoms included fever, altered consciousness, vomiting, and headaches.
• Key CSF findings were lymphocytic pleocytosis, hypoglycorrhachia, elevated protein, and a low CSF/serum glucose ratio.
• Hydrocephalus (87%) and basal exudates (50%) were prominent on CT scans.
• Neurological sequelae were observed in 71% of survivors, and 12% of patients expired.

Conclusions:

• Characteristic CSF abnormalities and the high prevalence of hydrocephalus are significant indicators for prompt antitubercular therapy.
• Early recognition of these findings is vital for improving outcomes in pediatric tuberculous meningitis.
• Multifaceted diagnostic approaches including CSF analysis and neuroimaging are essential for managing TBM.