Tuberculous Meningitis in Childhood

Abstract

Forty-three patients in the pediatric age group had tuberculous meningitis. Therapy included the use of adrenocorticosteroids. All four patients who were in stage 1 on admission to the hospital, seven of the 33 in stage 2, and one of the six in stage 3 (coma) recovered without gross neurological sequelas. Eight patients died, and the remaining 23 recovered, with late neurological sequelas. Early diagnosis and appropriate treatment determine the prognosis of tuberculous meningitis.

Tuberculous meningitis – clinical and laboratory review of 100 patients

“…The chest X-ray was helpful only when positive. Other series utilizing a routine chest X-ray Tuberculows meningiti8 235 236 M. E. KILPATRICK AND OTHERS as part of the diagnostic criteria had high positive rates (Voljavec, Orton & Corpe, 1959;Lincoln, Sordillo & Davies, 1960;Osuntokun, Adeuja & Familusi, 1971;Bobrowitz, 1972;Steiner & Portugaleza, 1973;Cardozo, Raidoro & Patel, 1976;Idriss, Sinno & Kronfol, 1976;Bwibo, 1979). In this series, chest X-rays were normal in 22 patients and suggestive of pulmonary tuberculosis in 34.…”

“…Mortality rates vary in reports on tuberculous meningitis (Lincoln & Sifontes, 1953;Lorber, 1954;Weiss & Flippin, 1965;Hassan & Abdel Wahab, 1969;Osuntokun, Adueja & Familusi, 1971;Steiner & Portugaleza, 1973;Escobar et al 1975;Visudhiphan & Chiemchanya, 1975;Idriss, Sinno & Kronfol, 1976;Kennedy & Fallon, 1979), reflecting basic health and nutrition of the population studied, patient age, severity of illness at the time of presentation for care, delay in starting anti-tuberculous therapy, and standards used to diagnose tuberculous meningitis. All patients in this series had laboratory confirmed tuberculous meningitis.…”

“…Partially treated purulent meningitis often presents CSF findings similar to tuberculous meningitis (Quaade & Kristensen, 1962). Data of several investigators revealed that only 48 % of the CSF samples examined from a total of 1098 patients suspected of having tuberculous meningitis were culture positive (Voljavec, Orton & Corpe, 1959;Lincoln, Sordillo & Davies, 1960;Weiss & Flippin, 1965; Osuntokun, Adeuja & Familusi, 1971;Bobrowitz, 1972;D'Oliveria, 1972;Steiner & Portugaleza, 1973;Escobar et al 1975;Sumaya et al 1975;Visudhiphan & Chiemchanya, 1975;Cardozo, Raidoro & Patel, 1976;Girgis et al 1976; Idriss, Sinno & Kronfol, 1976;Haas et al 1977; Bwibo, 1979;Kennedy & Fallon, 1979).…”

“…Mortality from tuberculous meningitis depends on patient age, clinical condition at admission, length of delay in starting therapy, and therapy used (Lincoln & Sifontes, 1953;Lorber, 1954; Forbes, 1960;Weiss & Flippin, 1965;Idriss, Sinno & Kronfol, 1976;Kennedy & Fallon, 1979). Intrathecal therapy combined with systemic therapy has been reviewed elsewhere (Lorber, 1954;Smith, 1956;Forbes, 1960;Fitzsimons & Smith, 1963;Hockaday & Smith, 1966;Freiman & Geefhuysen, 1970;Ware, 1971).…”

“…1975;Visudhiphan & Chiemchanya, 1975). The addition of steroids to antituberculous chemotherapy in tuberculous meningitis remains controversial (Cocci, 1956;Voljavec, Orton & Corpe, 1959;Hockaday & Smith, 1966;Freiman & Geefhuysen, 1970;Osuntokun, Adeuja & Familusi, 1971;Idriss, Sinno & Kronfol, 1976, Haas et al 1977. The routine use of steroids has improved survival but has also increased the incidence of neurologic sequelae (Freiman & Geefhuysen, 1970;Idriss, Sinno & Kronfol, 1976).…”