title: Tuberculous meningitis in children: clinical features and outcome in 40 cases.
abstract: In order to assess the epidemiology, clinical features and outcome of tuberculous meningitis, a retrospective review of patients was conducted between January 1989 and December 1995. Forty cases (representing 10%, of all paediatric patients with tuberculosis) were included. Mean age was 46 months (range 1-165 months). Eighteen (45%) children were classified as stage I (non-specific febrile illness without neurological signs), 16 (40%) as stage II (neurological signs without marked changes in sensorium) and 6 (15%) as stage III (major neurological signs with sensorial changes and/or coma). Twenty-seven (67%) patients had received BCG vaccination and 14 (35%) displayed an induration zone higher than 10 mm after a 2-TU PPD test. Mycobacterium tuberculosis was recovered from 24 (61%) patients. Hydrocephalus was demonstrated by cranial computed tomography in 31 (78%) children. Overall, 18 (45%) children had a full recovery. Mild, moderate and severe neurological sequelae were shown by 7 (18%), 3 (8%) and 9 (22%) of the patients, respectively. Three fatal cases (7%) were observed. The presence of seizures (RR 15.6, 2.02-119.1) and absence of extrameningeal foci (RR 4.95, 1.10-22.1) were identified as risk factors by multivariate analysis. These findings emphasize the need quickly to diagnose tuberculosis in children in order to give appropriate and early treatment.
authors.affiliation: Department of Infectious Diseases, Hospital de, Pediatría Professor Dr Juan P. Garrahan, Buenos Aires, Argentina.
authors.forename: H
authors.initials: H
authors.lastname: Paganini
authors.forename: F
authors.initials: F
authors.lastname: Gonzalez
authors.forename: C
authors.initials: C
authors.lastname: Santander
authors.forename: L
authors.initials: L
authors.lastname: Casimir
authors.forename: G
authors.initials: G
authors.lastname: Berberian
authors.forename: M T
authors.initials: MT
authors.lastname: Rosanova
mesh_terms: D000293:Adolescent; D001500:BCG Vaccine / Q000627:therapeutic use; D002555:Cerebrospinal Fluid / Q000737:chemistry / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000175:diagnosis; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012640:Seizures / Q000175:diagnosis; D016896:Treatment Outcome; D014390:Tuberculosis, Meningeal / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy
chemical_list: D001500:BCG Vaccine