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Tuberculous meningitis in children--clinical profile, mortality and morbidity of bacteriologically confirmed cases
N Thilothammal1, P V Krishnamurthy, K Banu
1Clinical Epidemiology Unit, Institute of Child Health and Hospital for
Insights
Tuberculous meningitis in children presents diverse neurological symptoms. Early diagnosis and treatment are crucial, as mortality within the first month reached 22% in this study.
Area of Science:
- Neurology
- Infectious Diseases
- Pediatrics
Background:
- Tuberculous meningitis (TBM) is a severe form of extrapulmonary tuberculosis.
- It disproportionately affects children, leading to significant mortality and long-term neurological deficits.
- Accurate and timely diagnosis remains a challenge, impacting treatment outcomes.
Purpose of the Study:
- To analyze the clinical presentation, mortality, and morbidity of tuberculous meningitis in children.
- To investigate the diagnostic utility of cerebrospinal fluid (CSF) findings in TBM.
- To evaluate outcomes in a cohort of TBM cases over a 1-year period.
Main Methods:
- A case-control study involving 107 children diagnosed with tuberculous meningitis between 1990 and 1992.
- Cerebrospinal fluid (CSF) analysis included smear microscopy and culture for acid-fast bacilli.
- Clinical examinations were conducted at admission, discharge, and a 1-year follow-up.
Main Results:
- A mortality rate of 22% was observed within the first month of illness.
- TBM cases exhibited varied clinical presentations, including acute neurological illness.
- Some cases showed minimal CSF cytological and biochemical changes despite positive culture results for acid-fast bacilli.
Conclusions:
- Tuberculous meningitis poses a significant threat to pediatric populations, with high early mortality.
- Clinical presentation can be diverse, underscoring the importance of microbiological confirmation.
- Prompt diagnosis and intervention are critical for improving outcomes in TBM.
Abstract:
One hundred and seven cases of tuberculous meningitis were registered as a part of a case-control study during the period 1990-1992. The CSF of all cases was positive for culture and/or smear for acid fast bacilli. Children were examined at the time of admission and at the time of discharge and they were contacted at the end of 1 year. Clinical picture, mortality and morbidity were analyzed. Mortality of children during the first month of illness was 22%. Some of the cases presented as acute neurological illness. We also came across CSF picture with minimal cytological and biochemical changes but with positive culture results.