Long-term follow up of childhood tuberculous meningitis.
The purpose of the present study was to determine the long-term outcome of 76 children (40 females and 36 males) diagnosed and treated with modern antituberculosis drugs. The median age of the children on admission was 29.5 months and on follow-up 9 years. Antituberculosis therapy consisted of daily isoniazid (20 mg/kg), rifampicin (20 mg/kg), ethionamide (20 mg/kg), and pyrazinamide (40 mg/kg) for 6 months. Twenty-three children received daily prednisone (2-4 mg/kg) for the first month of treatment. Raised intracranial pressure was actively monitored and treated. Patients with non-communicating hydrocephalus received ventriculo-peritoneal shunts shortly after admission while communicating hydrocephalus was treated with oral acetazolamide (100 mg/kg/day) and furosemide (1 mg/kg/day) in 3-4 divided doses. Communicating hydrocephalus that did not respond to this regimen within the first month of treatment also underwent ventriculo-peritoneal shunting. Only 20% of children were functionally completely normal at follow-up. Main areas of functional deficit were cognitive impairment (80%), poor scholastic progress (43%), and emotional disturbance (40%). Twenty-five per cent of children had evidence of motor impairment, but all could walk and only 5 of 76 children (6% of total) were unable to run. One child was blind but no child had sensori-neural deafness. It was concluded that these disabilities in children from mainly deprived socioeconomic backgrounds have serious implications for their future social, academic, and career prospects. A high index of suspicion of TBM in high tuberculosis incidence communities will help prevent the morbidity documented in this study.
Department of Paediatrics and Child Health, Tygerberg Children's Hospital, South Africa. jfs@gerga.sun.ac.za
J
J
Schoeman
J
J
Wait
M
M
Burger
F
F
van Zyl
G
G
Fertig
A Janse
AJ
van Rensburg
P
P
Springer
P
P
Donald
D000086:Acetazolamide / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use; D001921:Brain / Q000382:microbiology; D002648:Child; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D004232:Diuretics / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005000:Ethionamide / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D005665:Furosemide / Q000627:therapeutic use; D006801:Humans; D006849:Hydrocephalus / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D007538:Isoniazid / Q000627:therapeutic use; D008297:Male; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D011239:Prednisolone / Q000627:therapeutic use; D011718:Pyrazinamide / Q000627:therapeutic use; D011788:Quality of Life; D012293:Rifampin / Q000627:therapeutic use; D014390:Tuberculosis, Meningeal / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D017287:Ventriculoperitoneal Shunt; D014888:Wechsler Scales
D000893:Anti-Inflammatory Agents; D000995:Antitubercular Agents; D004232:Diuretics; D011718:Pyrazinamide; D005665:Furosemide; D011239:Prednisolone; D000086:Acetazolamide; D005000:Ethionamide; D007538:Isoniazid; D012293:Rifampin