title: Simultaneous tuberculous meningoencephalitis in two siblings.
abstract: The high morbidity and mortality of tuberculous meningoencephalitis (TBM) warrants an early diagnosis and treatment. BCG vaccine has been proven to reduce the incidence of disseminated disease in children. We report on two siblings (2-year-old boy and 4-year-old girl) with simultaneous TBM, whose parents originated from Kosovo, Albania, but presently reside in Germany. Early diagnosis of TBM was delayed, and at first the misdiagnosis of viral meningoencephalitis was made. Antituberculosis treatment was not initiated despite profound hyponatremia, hydrocephalus, and signs of inflammatory cerebral disease. After establishing the diagnosis of TBM, the boy died from antituberculosis, drug-induced hepatic failure; the sister survived with severe neurological deficits. Contact tracing revealed that TB had been transmitted by a household contact person with proven pulmonary TB who had refused antituberculosis treatment. A thorough contact investigation including tuberculin skin testing to identify children at risk for TB in the vicinity of this patient was not carried out. These case reports demonstrate an unusual simultaneous occurrence of TBM in a brother and sister. It draws attention to the importance of TBM as a differential diagnosis in children with suspected viral meningoencephalitis.
  
  
  CONCLUSIONS
  To prevent severe neurological sequelae, early antituberculosis therapy should be considered in infants and children with a clinical impression of meningitis in the context of cerebrospinal fluid white blood cell count of less than 500 cells/microl and lymphocytic predominance, hyponatremia, and possible hydrocephalus. This notion is especially true for children originating from high-endemicity countries for TB. A rigid implementation of antituberculosis treatment of infected individuals and contact tracing is mandatory in order to prevent dissemination of TB in the community. The use of BCG vaccine should be considered in children at high risk for TB infection because of its potential to reduce disseminated TB.
authors.affiliation: Department of Pediatrics and Paediatric Intensive Care, University Hospital of Saarland, Homburg, Germany. sascha.meyer@uniklinik-saarland.de
authors.forename: Sascha
authors.initials: S
authors.lastname: Meyer
authors.forename: Mohammed Ghiath
authors.initials: MG
authors.lastname: Shamdeen
authors.forename: Jörg
authors.initials: J
authors.lastname: Wüllenweber
authors.forename: Mathias
authors.initials: M
authors.lastname: Hermann
authors.forename: Sven
authors.initials: S
authors.lastname: Gottschling
authors.forename: Tobias
authors.initials: T
authors.lastname: Struffert
authors.forename: Ludwig
authors.initials: L
authors.lastname: Gortner
authors.forename: Markus
authors.initials: M
authors.lastname: Klotz
mesh_terms: D000415:Albania / Q000208:ethnology; D000995:Antitubercular Agents / Q000009:adverse effects / Q000627:therapeutic use; D001921:Brain / Q000473:pathology; D001925:Brain Damage, Chronic / Q000175:diagnosis; D002675:Child, Preschool; D016358:Contact Tracing; D003937:Diagnosis, Differential; D018450:Disease Progression; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D004641:Emigration and Immigration; D017809:Fatal Outcome; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008590:Meningoencephalitis / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology / Q000635:transmission*; D009460:Neurologic Examination; D035781:Siblings; D013307:Streptomycin; D014375:Tuberculoma / Q000175:diagnosis / Q000188:drug therapy / Q000635:transmission; D014390:Tuberculosis, Meningeal / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology / Q000635:transmission*
chemical_list: D000995:Antitubercular Agents; D013307:Streptomycin