Tuberculous meningitis in children

Altunbaşak, Şakìr; Alhan, Emre; Baytok, Vildan; Aksaray, Necmi; Yüksel, Bilgin; Önenli, Neslihan

doi:10.1111/j.1442-200x.1994.tb03229.x

Cited by 7 publications

(9 citation statements)

References 15 publications

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“…In another study in Turkey, hydrocephalus was present in 98% of 52 patients with TBM. 20 Finally, in a Chinese study of children with CNS TB diagnosed between 1961 and 1984, the clinical stage at presentation and age were the primary predictive variables of prognosis. 21 Communicating hydrocephalus in CNS TB usually is caused by blockage of the basilar cistern with thick tuberculous exudates in the acute stage and adhesive leptomeningitis in the chronic stage of disease.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 1998

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 1998

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“…O estadiamento clínico é reconhecido como o principal determinante do prognóstico desde o iní-cio da era quimioterápica do tratamento da tuberculose do SNC 11,18,[25][26][27][28][29][30] . No presente estudo, houve uma tendência de pior prognóstico entre os pacientes que apresentavam diminuição do nível de consciência no início do tratamento, porém, sem significância estatística (p=0,140).…”

Section: Resultsunclassified

Tuberculose do sistema nervoso central em crianças: 2. Tratamento e evolução

Filho

Marques-Dias

Marques

et al. 2001

Arq. Neuro-Psiquiatr.

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RESUMO -Sequelas neurológicas não são raras após o tratamento da tuberculose do sistema nervoso central (SNC), que é longo, trabalhoso e sujeito a complicações. Vários fatores são implicados como determinantes de prognóstico. O objetivo deste estudo foi analisar o tratamento e a evolução de 52 crianças com tuberculose do SNC de um hospital pediátrico terciário. A maioria dos pacientes (41 ou 78,8%) utilizou corticosteróides associados ao esquema tríplice. A ocorrência de hidrocefalia foi comum (28 de 41 testados), porém apenas 8 (15,4%) necessitaram de derivação liquórica. Hiponatremia ocorreu em um terço dos casos testados. Hepatotoxicidade ao esquema tríplice aconteceu em 32 casos (61,5%), porém apenas 3 (9,4%) necessitaram de substituição destas drogas. Ocorreram 8 (15,4%) óbitos e 24 (46,1%) casos desenvolveram sequelas ao fim do tratamento. Houve tendência de pior prognóstico entre os pacientes que não usaram corticosteróides e os que apresentavam doença avançada ao diagnóstico.PALAVRAS-CHAVE: tuberculose, meningoencefalite, sistema nervoso central, crianças, tratamento, evolução.Central nervous system tuberculosis in children: 2. Treatment and outcome ABSTRACT -Neurologic damage is usual after central nervous system (CSN) tuberculosis recovery. Treatment is long, difficult and prone to complications. Many factors are enrolled as prognostic determinants. This study aimed to describe the treatment and outcome of 52 children with CNS tuberculosis of a tertiary pediatric hospital. All of them received standard triple drug regimen, and 41 (78.8%) received corticosteroids as adjunctive therapy. Hydrocephalus was common (28 of 41 tested), but only 8 (15.4%) patients underwent ventricular shunt surgery. Hepatotoxicity to anti tuberculosis drugs occurred in 32 (61.5%) cases, but in only 3 (9.4%) drug substitution was necessary. There were 8 (15.4%) deaths and 24 (46.1%) cases developed neurologic damage after therapy. Patients who did not receive steroids during treatment and those with advanced neurological involvement at diagnosis showed a tendency to worse prognosis. O acometimento do sistema nervoso central (SNC) é uma das formas mais temidas da tuberculose na infância, pela morbi-mortalidade que costuma causar. O comprometimento neurológico, quando não fatal, costuma deixar sequelas de grau variável, que se manifestam como déficits motores, retardo do desenvolvimento ou demência mental, síndromes convulsivas e hidrocefalia 1 . O tratamento da criança com tuberculose do SNC baseia-se no uso do esquema tríplice associado a corticosteróides. Complicações, tais como hidrocefalia com hipertensão intracraniana, distúrbios metabólicos e efeitos adversos às próprias drogas do esquema tríplice, podem interferir negativamente no prognóstico quando não corrigidas em tempo. O aumento da pressão intracraniana, além de levar risco à vida do paciente, prejudica o aporte de drogas ao tecido nervoso 2,3 . Cirurgias de derivação ventricular são por vezes necessárias para o alívio da hidrocefalia. Dentre os distúrbios metabólic...

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“…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

“…Considerando-se os valores limites da duração de cada sintoma, pode-se concluir que nesta série houve casos tanto de evolução aguda (1 dia) quanto de evolução bastante prolongada (241 dias). Grande parte dos autores concorda em afirmar que o diagnóstico da tuberculose do SNC em crianças costuma ser firmado durante a segunda e terceira semanas de doença 12,[14][15][16] . É plenamente estabelecido que a identificação do foco transmissor da doença, geralmente um adulto no mesmo domicílio, é de grande valia no diagnóstico da tuberculose na infância 17 .…”

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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Tuberculous meningitis in children

Cited by 7 publications

References 15 publications

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

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

Tuberculose do sistema nervoso central em crianças: 2. Tratamento e evolução

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

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