title: Coagulant and fibrinolytic status in tuberculous meningitis.
abstract: BACKGROUND
  The long-term neurologic sequelae of childhood tuberculous meningitis (TBM) mainly result from ischemia owing to cerebral vasculitis. Deep vein thrombosis occurs in adults with pulmonary tuberculosis owing to hypercoaguability. The present study aimed to investigate coagulation status during acute childhood TBM.
  
  
  METHODS
  Coagulation status, including the natural anticoagulants, antithrombin, protein C and protein S; procoagulant FVIII; fibrinolytic factors, tissue plasminogen activator and plasminogen activator inhibitor-1 (PAI-1) as well as anticardiolipin antibodies (ACA), was determined in 16 children with TBM before and during treatment.
  
  
  RESULTS
  A prothrombotic profile was found as expressed by a decrease of anticoagulant (protein S) and increase of the procoagulant (factor VIII) activity. Raised PAI-1 and normal tissue plasminogen activator values indicated deficient fibrinolysis. This hypercoagulable state was more pronounced in stage 3 patients than in stage 2 patients. The bleeding time on admission ranged from 1.2 to 10 minutes [mean 4.2 minutes]. The mean platelet count on admission was 577.9 +/- 188.6 x 10/L and increased further during the course of the treatment.
  
  
  CONCLUSIONS
  The hypercoagulable state in childhood TBM is comparable to that described in adults with pulmonary tuberculosis and may further increase the risk for infarction. Therapeutic measures that reduce the risk for thrombosis could therefore be potentially beneficial in childhood TBM.
authors.affiliation: Department of Paediatrics and Child Health, Tygerberg Hospital, University of Stellenbosch and NHLS, Tygerberg, South Africa.
authors.forename: Johan
authors.initials: J
authors.lastname: Schoeman
authors.forename: Erna
authors.initials: E
authors.lastname: Mansvelt
authors.forename: Priscilla
authors.initials: P
authors.lastname: Springer
authors.forename: Anita Janse
authors.initials: AJ
authors.lastname: van Rensburg
authors.forename: Sophia
authors.initials: S
authors.lastname: Carlini
authors.forename: Elba
authors.initials: E
authors.lastname: Fourie
mesh_terms: D001241:Aspirin / Q000627:therapeutic use; D001777:Blood Coagulation; D002648:Child; D002675:Child, Preschool; D005342:Fibrinolysis; D006801:Humans; D007223:Infant; D010976:Platelet Count; D015912:Thrombolytic Therapy; D014390:Tuberculosis, Meningeal / Q000097:blood*
chemical_list: D001241:Aspirin