Central Nervous System Tuberculosis in Children: A Review of 214 Cases

Abstract

ABSTRACT. Objective. To study the clinical, laboratory, and treatment features observed in pediatric patients with tuberculous meningitis in Turkey.Study Design. 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. Pediatrics 1998;102(5). URL: http://www.pediatrics.org/cgi/content/full/102/5/e49; central nervous system, tuberculous meningitis, diagnosis, hydrocephalus, children.

Adenosine Deaminase (ADA) in Tuberculous Meningitis

“…One series of non-HIV-infected adult cases of CNS tuberculosis in Turkey found CSF lymphocyte predominance in 85%, neutrophil predominance in 15%, high protein levels in 77%, hypoglycorrachia in 67.2%, and elevated opening pressure in 54% of patients (Sutlas et al 2003). Similar results among a series of pediatric cases were also noted (Yaramis et al 1998), and coinfection with HIV does not appear to alter the CSF proûle (Thwaites et al 2005). Although hypoglycorrachia is common in both bacterial meningitis and TBM, its presence may provide a convenient discriminating feature that distinguishes these etiologies from most other causes of meningoencephalitis, especially when considering the initiation of empirical antibiotics.…”

Central Nervous System Tuberculosis: Pathogenesis and Clinical Aspects

“…Both children (56) and HIV-coinfected patients (14,52,169) are at high risk for developing CNS tuberculosis. Other risk factors include malnutrition and recent measles in children (246) and alcoholism, malignancies, and the use of immunosuppressive agents in adults (101,143,233). Studies conducted in developed countries have also identified that foreign-born individuals (individuals born outside of developed countries) are overrepresented among CNS tuberculosis cases (19,157).…”

“…Children with TBM often present with fever, stiff neck, seizures, and abdominal symptoms such as nausea and vomiting (57,246). Headache occurs less often than in adults.…”

Reacción paradojal en meningitis tuberculosa. Presentación de un caso

“…El conjunto de fenómenos patogénicos (vasculitis, isquemia, edema cerebral, granulomas e hidrocefalia) desencadenados a partir de la lesión tuberculosa son los responsables de los defectos motores, sensoriales y del intelecto que se manifiestan durante la evolución de estos pacientes. [5][6][7] Tal es el caso del paciente que presentamos, en quien las manifestaciones neurológicas no pueden explicarse exclusivamente por el compromiso meníngeo y la localización de los granulomas.…”