title: Presentation and outcome of tuberculous meningitis among children: experiences from a tertiary children's hospital.
abstract: BACKGROUND
  Diagnosis of tuberculous meningitis (TBM) is complicated and outcome is poor especially in resource limited settings. Early diagnosis and prompt treatment are vital in effective treatment. We set out to describe experiences in the management and immediate outcome of TBM a tertiary-level children's hospital in a high HIV and tuberculosis co-infection setting.
  
  
  METHODS
  This retrospective study included children who were diagnosed with TBM in the year 2009. A pre-coded questionnaire was used to extract data on presentation, diagnostics, treatment and outcome at the time of hospital discharge. Data was analyzed using STATA statistical package (StataCorp, Version 11).
  
  
  RESULTS
  Of the 40 children diagnosed with TBM, 6 (15%) had definitive TBM, 17 (42.5%) had probable TBM and 17 (42.5%) had possible TBM. The cerebrospinal fluid (CSF) chemistry and cells were abnormal in 39/40 (98%). Mantoux test was reactive in 16/29 (55%) and 17/30 (57%) had Chest X-rays suggestive of tuberculosis. Only 3/21 (14%) had positive sputum tuberculosis culture and 89% (32/36) had neuro-imaging abnormalities. Outcome at discharge was; 8% died, 49% improved with neurological sequelae and 43% improved without sequelae. Having TBM stage 3 at admission was associated with mortality (p=0.001).
  
  
  CONCLUSIONS
  Most children had early diagnosis of TBM and mortality was lower than in previous studies. We recommend a larger prospective study to further understand the outcome of TBM.
authors.affiliation: Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Nicolette
authors.initials: N
authors.lastname: Nabukeera-Barungi
authors.affiliation: Red Cross War Memorial Children's Hospital and the School of Child and Adolescent Health, University of Cape Town.
authors.forename: Jo
authors.initials: J
authors.lastname: Wilmshurst
authors.affiliation: Red Cross War Memorial Children's Hospital and the School of Child and Adolescent Health, University of Cape Town.
authors.forename: Muloiwa
authors.initials: M
authors.lastname: Rudzani
authors.affiliation: Red Cross War Memorial Children's Hospital and the School of Child and Adolescent Health, University of Cape Town.
authors.forename: James
authors.initials: J
authors.lastname: Nuttall
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use; D002675:Child, Preschool; D006257:Head / Q000000981:diagnostic imaging; D006801:Humans; D015994:Incidence; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013019:South Africa / Q000453:epidemiology; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014390:Tuberculosis, Meningeal / Q000134:cerebrospinal fluid / Q000453:epidemiology* / Q000628:therapy
chemical_list: D000995:Antitubercular Agents
keywords: Africa; Tuberculous meningitis; children; outcome; presentation