Background: Children with tuberculous meningitis (TBM) present with diagnostic challenges as they often have atypical clinical features.
Objective: To describe the baseline characteristic features of children diagnosed with central nervous system (CNS) TB (TBM and tuberculoma).
Design: Retrospective descriptive study.
Methods: Children less than 12 years presenting with neurological signs and symptoms were assessed for a therapeutic TBM trial eligibility. The results of their clinical, laboratory, neuroimaging, cerebrospinal fluid evaluations were analysed for TBM diagnosis.
Results: Of 600 children evaluated, 61(10%) had CNS tuberculosis; TBM 47, tuberculoma 14. 20(33%) had definite TBM. Mean age of children with TBM was 5 ± 3.4 years. Of 47, 13(28%), 21(45%) and 13(28%) had grade I, II, and III disease respectively. Abnormalities suggestive of TBM in MRI and computed tomography brain were observed in 76% (26/34) and 77% (24/31) respectively. Abnormal cerebrospinal fluid white blood cell count, protein and glucose were observed in 56% (24/43), 49% (22/45), 47% (21/45) respectively. Among 41 patients with TBM followed up until discharge, five died.
Conclusion: Younger children with TBM have severe forms. Confirmatory results may not be available in all. A holistic approach to care including addressing complications of hydrocephalus and strokes is needed.
Keywords: CNS tuberculosis; children; paediatric TBM; tuberculous meningitis.
Clinical features, results of brain imaging and other tests in the cerebrospinal fluid among children diagnosed with tuberculous meningitis – descriptive study Why was the study done? What did the researchers do? Records of children aged between 6 months and 12 years who presented to the health care centre with signs and symptoms of central nervous system (CNS) disease and assessed for tuberculous meningitis (TBM) clinical trial eligibility were reviewed. The research team studied the signs and symptoms of the TBM, results of the CT/MRI brain scan and tests which were done in the cerebrospinal fluid (CSF) during hospitalization. What did the researchers find? Total number of children who presented to the health centre during the study period with CNS complaints and underwent lumbar puncture were 600. Among them 61 were diagnosed with CNS TB (47 had TBM and 14 had tuberculoma). Half of them were less than five years of age. Ten had neurological dysfunction. Fever, vomiting were the common complaints. Almost half of the children had vomiting, altered level of consciousness and seizures. Tests done in the CSF detected the bacteria causing TBM in half of the children. Abnormal cell counts or biochemical changes in the CSF specific to TBM were observed in half of the children. Abnormalities in CT/MRI imaging with features specific to the disease were observed in closer to three fourth of the children. What do the findings mean? Children with TBM often present late for care with severe forms and its complications. There would be diagnostic challenges as the symptoms were vague and might not present in a specific manner, specific tests in the CSF could be negative and if undiagnosed could lead to severe morbidity impacting the quality of life or death. Taking the overall picture of presenting complaints, results of CSF test and brain scan and with high degree of suspicion, TBM should be diagnosed early and managed appropriately.
© The Author(s), 2024.