Tuberculous meningitis in children during the isoniazid era

Sumaya, Ciro V.; Simek, Merlin; Smith, Margaret H. D.; Seidemann, Michael F.; Ferriss, Gregory S.; Rubin, Wallace

doi:10.1016/s0022-3476(75)80066-7

Cited by 52 publications

(20 citation statements)

References 22 publications

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“…O diagnóstico de tuberculose do SNC nas crianças desta série foi baseado, não só na identificação do agente por métodos microbiológicos, mas também em dados clínicos, laboratoriais e epidemiológicos, de modo semelhante a outras casuísticas que envolvem crianças [10][11][12][13][14][15][16] .…”

Section: Discussionunclassified

“…A maioria dos autores concorda em afirmar que a faixa etária alvo da tuberculose do SNC em crianças é a que vai até os 5 anos de idade, como foi constatado neste estudo 11,12,[14][15][16] .…”

Section: Discussionunclassified

“…Nesta série, o índice de recuperação do agente etiológico foi baixo (23,4%), porém em conformidade com o descrito em literatura 11,[14][15][16] . O exame microbiológico do lavado gástrico mostrou melhores resultados quando comparado ao líquor (25,6%), enquanto que nos demais líquidos corpó-reos testados os resultados foram semelhantes.…”

Section: Discussionunclassified

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Tuberculose do sistema nervoso central em crianças: 1. Apresentação clínica e laboratorial

Filho

Marques

Marques-Dias

et al. 2001

Arq. Neuro-Psiquiatr.

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Tuberculosis still occupies a remarkable place as a worldwide health problem, chiefly in emerging countries, like Brazil. The central nervous system (CNS) involvement by Mycobacterium tuberculosis is one of the most feared features of disease, because of its high morbidity and mortality. This study aimed to describe some epidemiological, clinical and laboratorial aspects of 52 children in a tertiary pediatric hospital with CNS tuberculosis. At diagnosis, the majority of patients showed low age, compromised nutritional status, previous contact with bacillary individuals, delayed or absent immunization, advanced neurological signs and compatible abnormalities in cerebrospinal fluid (CSF) analysis and in radiological findings. The etiologic agent was identified by staining methods or CSF and other fluids culturing in 40% of patients. In most cases, despite of suggestive clinical, epidemiological and laboratorial picture and feasibility of patients access to health care centres, therapy was started late.

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Section: Discussionunclassified

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Tuberculose do sistema nervoso central em crianças: 1. Apresentação clínica e laboratorial

Filho

Marques

Marques-Dias

et al. 2001

Arq. Neuro-Psiquiatr.

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“…Despite the availability of many excellent antituberculous agents, CNS tuberculous in children still carries significant morbidity and mortality rates between 15% to 32% [4][5][6][7][8]. Fatality rates and neurologic sequelae depend on many factors, including age of the patient, nutritional status, time of diagnosis, stage of disease at presentation and institution of appropriate antituberculous therapy.…”

Section: Introductionmentioning

confidence: 99%

Tuberculous meningitis in children

Waecker

2002

Curr Treat Options Neurol

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Initial empiric treatment for central nervous system (CNS) tuberculosis should include four antituberculous drugs until results of cultures and sensitivities are available. Treatment should include isoniazid, rifampin, pyrazinamide, and either ethambutol or streptomycin. Total treatment should extend for 12 months. Daily therapy should be used for the first 2 months, followed by either twice a week treatment or continued with daily therapy for the duration with directly observed therapy (DOT). Pyrazinamide should be included in all treatment regimes for the first 2 months of therapy. Corticosteroids should be used in the management of children with tuberculous meningitis. Corticosteroids have been shown to decrease mortality, long-term neurologic complications, and permanent sequelae. Prednisone is often used at a dosage of 1 to 2 mg/kg per day. Steroids should be used for 4 to 6 weeks, and then tapered over the next 2 to 3 weeks. Cerebrospinal fluid (CSF) cultures and other infected sites must be aggressively pursued in order to obtain an organism for identification and sensitivities testing. Cranial CT scans with contrast should be included in the early diagnostic work-up of a child with suspected CNS tuberculosis infection. Hydrocephalus is often an early finding and may be helpful in establishing the diagnosis of CNS tuberculosis. Treatment of CNS tuberculosis should be for 12 months. All children with CNS tuberculosis should be promptly reported to the local public health department. Public health will facilitate the case-contact study and assist with follow-up and DOT after discharge. Directly observed therapy should be given for the entire treatment course. This is best accomplished with the collaboration of local public health services. Children with tuberculous meningitis should be evaluated in follow-up monthly. Monitoring should include determining adherence to drug treatment, an interval history for signs and symptoms of disease progression, careful physical examinations and evaluation for adverse effects of drugs. Liver function tests should be obtained at baseline, 2-, 4-, 6-, and 8 weeks, and then monthly for the first several months of treatment. Children with tuberculous meningitis should be tested for HIV infection, including pre- and post-test counseling.

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“…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).…”

Section: Introductionmentioning

confidence: 99%

Tuberculous meningitis – clinical and laboratory review of 100 patients

Kilpatrick

Girgis

Yassin

et al. 1986

J. Hyg.

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SUMMARYIn developing countries tuberculous meningitis is a difficult infection to differentiate from other central nervous system (CNS) infections. This paper presents the history, physical findings, laboratory data, and clinical course of 100 patients who were admitted to a special ward and had CSF cultures positive for Mycobacterium tuberculosis. Fifty-four patients were comatose when admitted and 76 had meningeal signs. Mean admission CSF values were WBC 531, glucose 23 mg/dl, and protein 166 mg/dl. Only two CSF AFB smears were positive. Sixty-one percent of the chest X-rays taken were consistent with pulmonary tuberculous and 390 were normal. Twenty-four patients died within the first week after admission, before the clinical diagnosis was made and anti-tuberculous therapy could be started. Fifty-three of 76 patients given antituberculous therapy died. Neurologic sequelae developed in 48 % of the survivors. The high mortality and morbidity rates in this patient-group were due to the severity of illness on admission and the predominance of children (54 %).

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Tuberculous meningitis in children during the isoniazid era

Cited by 52 publications

References 22 publications

Tuberculose do sistema nervoso central em crianças: 1. Apresentação clínica e laboratorial

Tuberculose do sistema nervoso central em crianças: 1. Apresentação clínica e laboratorial

Tuberculous meningitis in children

Tuberculous meningitis – clinical and laboratory review of 100 patients

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