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Central nervous system tuberculosis in children: a review of 214 cases
A Yaramiş1, F Gurkan, M Elevli
1Division of Pediatric Diseases, Medical School, Dicle University, Diyarbakir, Turkey.
Insights
Pediatric tuberculous meningitis (TBM) in Turkey predominantly affects children under five and often presents with a family history of TB and abnormal chest X-rays. Diagnosis relies on a combination of clinical, tuberculin skin test, and cerebrospinal fluid findings, with a 23% mortality rate.
Area of Science:
- Pediatric Infectious Diseases
- Neurology
- Public Health
Background:
- Tuberculous meningitis (TBM) is a severe form of extrapulmonary tuberculosis affecting the central nervous system.
- Early diagnosis and treatment are crucial for improving outcomes in pediatric TBM.
- Understanding the clinical, laboratory, and treatment characteristics is essential for managing this disease in specific populations.
Purpose of the Study:
- To investigate the clinical, laboratory, and treatment features of pediatric tuberculous meningitis in Turkey.
- To identify key diagnostic indicators and complications associated with TBM in children.
- To evaluate the treatment strategies and outcomes in this patient cohort.
Main Methods:
- A retrospective case review of 214 pediatric patients diagnosed with central nervous system tuberculosis (TB) between 1988 and 1996.
- Data collected included demographics, medical history, clinical presentation, diagnostic test results (Mantoux test, CSF analysis, radiography), complications, and treatment regimens.
- Analysis of treatment outcomes, including mortality rates and interventions for complications like hydrocephalus.
Main Results:
- The majority of the 214 pediatric TBM patients (77%) were under five years old, with a male predominance (52%).
- Common findings included a family history of TB (66%), abnormal chest radiography (87%), and hydrocephalus (80%).
- Cerebrospinal fluid analysis revealed positive acid-fast bacilli smear in only 13% and Mycobacterium tuberculosis isolation in 30% of cases; the overall mortality rate was 23%.
Conclusions:
- A combination of family history of TB, positive tuberculin skin test, abnormal cranial CT, and CSF analysis suggestive of TBM aids in diagnosis.
- Hydrocephalus is a frequent complication requiring surgical intervention.
- Despite treatment with standard anti-TB drugs and steroids, pediatric TBM remains associated with significant morbidity and mortality.
Objective:
To study the clinical, laboratory, and treatment features observed in pediatric patients with tuberculous meningitis in Turkey. Study Design. Retrospective case review study.
Methods:
Review of medical records for demographic data, medical history, clinical manifestations, auxiliary test results, complications, and treatment of 214 children with central nervous system tuberculosis (TB) admitted to Dicle University's hospital between August 1988 and February 1996.
Results:
Of the 214 patients with tuberculous meningitis, 112 (52%) were male. The mean age at presentation was 4. 1 years, with 165 patients (77%) younger than 5 years. Twenty-two patients (10%) were in the first stage of the disease, 120 (56%) in the second, and 72 (34%) in the third. Our epidemiologic data showed that 141 (66%) of the patients had a family history of TB, and 64 (30%) had a Mantoux skin test result of >10 mm of induration. Radiographic studies demonstrated abnormal chest findings in 187 patients (87%) (hilar adenopathy, 33%; infiltrates, 33%; miliary pattern, 20%; and pleural effusions, 1%, and 172 (80%) cases with hydrocephalus, 26% with parenchymal disease, 15% with basilar meningitis, and 2% with tuberculomas. Only 22 (13%) of 164 children had a positive acid-fast bacilli smear in cerebrospinal fluid, and Mycobacterium tuberculosis was isolated in 49 patients (30%). All the patients were treated with Isoniazid, rifampin, and streptomycin or pyrazinamide for 2 months, followed by 10 months of Isoniazid and rifampin alone. Also, all the patients received adjuvant treatment with steroids early in the course of treatment, and 140 of 172 cases with hydrocephalus had surgical intervention. The overall mortality rate was 23%.
Conclusion:
One or more of these findings: a family history of TB, positive tuberculin skin test results, abnormal cranial computed tomography, and/or cerebrospinal fluid analysis compatible with TBM were found in all but 3 children in our study. central nervous system, tuberculous meningitis, diagnosis, hydrocephalus, children.