Tubercular meningitis in children: Clinical, pathological, and radiological profile and factors associated with mortality

Abstract

Context:Childhood tuberculosis is a major public health problem in developing countries with tubercular meningitis being a serious complication with high mortality and morbidity.Aim:To study the clinicopathological as well as radiological profile of childhood tuberculous meningitis (TBM) cases.Settings and Design:Prospective, observational study including children <14 years of age with TBM admitted in a tertiary care hospital from Western India.Subjects and Methods:TBM was diagnosed based on predefined criteria. Glassgow coma scale (GCS) and intracranial pressure (ICP) was recorded. Staging was done as per British Medical Council Staging System. Mantoux test, chest X-ray, cerebrospinal fluid (CSF) examination, neuroimaging, and other investigations were done to confirm TB.Statistical Analysis Used:STATA software (version 9.0) was used for data analysis. Various risk factors were determined using Chi-square tests, and a P< 0.05 was considered significant.Results:Forty-seven children were included, of which 11 (24.3%) died. Fever was the most common presenting symptom, and meningismus was the most common sign. Twenty-nine (62%) children presented with Stage III disease. Stage III disease, low GCS, and raised ICP were predictors of mortality. Findings on neuroimaging or CSF examination did not predict mortality.Conclusions:Childhood TBM presents with nonspecific clinical features. Stage III disease, low GCS, lack of Bacillus Calmette–Guérin vaccination at birth and raised ICP seem to the most important adverse prognostic factors.

Epidemiological, Clinical characteristics and Drug resistance situation of Culture-confirmed Children TBM in Southwest of China: A 6-Year Retrospective Study

“…Fever (90.5%), headache (71.4%) and cough (45.2%) were the most common symptoms, more severe symptoms like neck stiffness, vomiting and disturbance of consciousness were present in 35/42 (83.3%), 22/42(52.4%), and 14/42 (33.3%) respectively. The occurrence of these symptoms was similar or higher as compared to earlier studies [10][11][12][13].Children with TBM during hospitalization showed varying degrees of antituberculosis-drug induced hyperuricemia (23.8%) and hepatotoxicity(31.0%), these common adverse event associated with TB treatment ratio in this study were higher as compared to previous studies [3,14]. This may be the development of liver and kidney function in children is not perfect, the ability to remove drugs is poor, and they are more sensitive to drug reactions and more prone to adverse reactions than adults.…”

Acute Febrile Encephalopathy in Children: A Prospective Study of Clinical Features, Etiology, Mortality, and Risk Factors from Western India

“…CSF anti-N-methyl-D-aspartate receptor antibody, Anti-voltage gated potassium channel antibody, etc.). [ 17 ] However, again, in the earlier study by Kumar et al ., even with extensive investigations for viral etiology, 40% cases remained etiologically unexplained. [ 6 ] The above-mentioned investigations are also not routinely available in most of the secondary and tertiary level health-care facilities of India and other developing countries, where such patients are being managed.…”

“…[ 16 ] A diagnosis of raised intracranial tension was made when two or more of the following were present: hypertension, bradycardia, irregular respiration, abnormal tonic posturing, bulging, and nonpulsatile anterior frontanel when they are open, presence of crack-pot sign, and papilledema on direct ophthalmoscopy when fontanel are closed. [ 17 ]…”

Modifying Cerebrospinal Fluid Constants for the Tuberculousis Etiology of a Meningitis Case

“…Generally, treatment should last for at least nine months and contain tuberculostatics in the quadruple combination. Adjuvant treatment with corticosteroids should be considered (9).…”

“…The introduction of treatment with antituberculous, chemotherapeutic agents such as isoniazid, rifampicin and streptomycin, subsequently pyrazinamide and ethambutol to which cortisone has been judiciously associated, improved prognosis. However, a more important role than the choice of treatment regimen is to initiate treatment as close as possible to the onset of the disease (9).…”