Tuberculous Meningitis in Bacille Calmette-Guérin–Vaccinated Children

Khémiri, M.; Bagais, Abderrahmen; Bêcher, S. Ben; Bousnina, S.; Bayoudh, Fethi; Munaz, Ahmed; Lakhoua, R.; Barsaoui, S.

doi:10.1177/0883073811426930

Cited by 4 publications

(2 citation statements)

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“…Initial signs and symptoms of disease are non-specific, and the suspicion of TBM usually arises only some days or weeks after the disease's onset and is not different in children who have or have not been vaccinated with BCG. Fever, headache, anorexia, and vomiting characterize the prodromal of the disease in older children, whereas failure to thrive, poor appetite, vomiting, and sleep disturbances are more common in younger ones (7). Tuberculous meningitis is more easily suspected, when these symptoms are associated with a history of recent contact with a case of documented TB.…”

Section: Discussionmentioning

confidence: 99%

Tuberculous Meningitis in Two-Year-Old Male Boy: Evidence of Recent Transmission from Mother to Baby

Patil¹,

Nagargoje²,

Choudhary³

2017

Respir Case Rep

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Tuberculous (TB) meningitis is the commonest infectious disease of central nervous system in pediatric and geriatric cases. Tuberculosis can be prevented in children by diagnosing and treating cases of active TB amongst adults, as pediatric cases always acquire it passively from household contact of adults suffering from TB as disease in adults is multibacillary. Although significant data is available for the prevention of childhood extra-pulmonary and disseminated TB, offering them Bacillus Calmette-Guerin (BCG) vaccination, it is still not routinely offered during vaccination. In this case report, a two-year child with a history of failure to thrive and constitutional symptoms diagnosed with disseminated extra-pulmonary TB presenting as TB meningitis with a history of contact with the mother suffering from active sputum positive pulmonary TB receiving anti-TB treatment. In conclusion, we recommend BCG vaccination to all newborns, and tuberculin skin testing and isoniazid prophylaxis to the contact of adults with sputum positive pulmonary TB cases in India. ÖzetTüberküloz menenjit, pediatrik ve geriatrik olgularda en sık görülen santral sinir sistemi enfeksiyonudur. Pediatrik olgular, basil yayan erişkin tüberküloz hastaları ile yakın temas sonucu hasta oldukları için aktif erişkin tüberküloz olgularının tanı ve tedavilerinin yapılması ile çocukların bu hastalıktan korunması mümkün olabilir. Çocukluk çağında yapılan BCG aşılanması ile akciğer dışı ve yaygın tüberkülozdan çocukların korunduklarına dair anlamlı veriler bulunmasına rağmen, halen aşılama rutin olarak yapılma-maktadır. Bu olgu sunumunda, gelişme geriliği ve konstitüsyonel semptomları olan ve yaygın akciğer dışı tüberkülozun menenjit formunda ortaya çıktığı, iki yaşındaki çocuk sunulmuştur. Çocuğun tüberküloz yakın teması olarak annesinin yayma pozitif akciğer tüberkülozu olduğu ve antitüberküloz tedavi aldığı belirlenmiştir. Sonuç olarak, Hindistan'da, tüm yeni doğanlara BCG aşısı yapılmasını ve yayma pozitif akciğer tüberkülozlu erişkinlerin temaslılarının tüber-külin testinin yapılarak isoniyazid proflaksisine alın-masını tavsiye ediyoruz.Anahtar Sözcükler: Tüberküloz menenjit, BCG aşısı, isoniyazid, tüberkülin deri testi, anneden çocuğa bulaşma.

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Section: Discussionmentioning

confidence: 99%

Tuberculous Meningitis in Two-Year-Old Male Boy: Evidence of Recent Transmission from Mother to Baby

Patil¹,

Nagargoje²,

Choudhary³

2017

Respir Case Rep

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“…However, even with BCG vaccination, tuberculous meningitis remains a life-threatening condition, and vaccinated children still have common presentation in terms of severity and poor outcome. 6 Thus, early diagnosis is lifesaving. The definitive and rapid diagnosis of central nervous system tuberculosis depends upon the detection of M. tuberculosis bacilli in the CSF.…”

Section: Discussionmentioning

confidence: 99%

An 11-Year-Old Boy with Headache, Fever, and Neck Pain

Yış¹,

Polat²,

Karaoğlu³

et al. 2015

Pediatr Ann

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A n 11-year-old-boy was admitted to the pediatric emergency department with 5 days of headache that was bilateral, throbbing, and progressively worsening. It was associated with fever, vomiting, neck pain, and stiffness. He was previously diagnosed as having acute sinusitis, given oral amoxicillin, and discharged from the hospital. Prior to his presentation he was a healthy boy and had no history of headache, chronic illness, recent vaccinations, cutaneous rash, cough, diarrhea, arthralgia, or myalgia. He had two scars of Bacille Calmette-Guerin (BCG) vaccine. Axillary temperature on admission was 38.5°C.On physical examination, his weight and height were 33.5 kg and 145 cm, respectively. His mental status was alert and attentive. He had meningismus with increased deep tendon reflexes. There were no papilledema or focal neurologic signs. Cerebrospinal fluid (CSF) had a white blood cell count of 170/mcL (neutrophil predominant); protein of 89.1 mg/dL (normal range, 15-40 mg/dL); and glucose of 33 mg/dL (CSF to serum glucose ratio of 0.33). Computed tomography (CT) scan of the head on the day of admission was normal. Acute bacterial meningitis was suspected, so ceftriaxone (100 mg/kg per day) and vancomycin (60 mg/kg per day) were administered. The patient had four generalized convulsions on the first day of hospitalization, and he developed diplopia with increased headache intensity.Neurologic examination revealed left abducens nerve palsy. Magnetic resonance imaging with gadolinium contrast was normal. Chest radiograph was clear. CSF gram stain, cultures and acid fast bacilli smear, purified protein derivative (PPD) test, and blood and urine cultures were all negative. On the second day of hospitalization, he began to show signs of increased intracranial pressure with papilledema. His mental status was still alert.

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