title: Tuberculous Meningitis in Children and Adults: A 10-Year Retrospective Comparative Analysis.
abstract: BACKGROUND
  Tuberculous meningitis (TBM) is the most lethal form of Mycobacterium tuberculosis infection, which has a high rate of neurological complications and sequelae.
  
  
  OBJECTIVE
  Our study offers a real-world infectious disease clinic perspective, being thus representative for the clinical environment of developing countries.
  
  
  METHODS
  We performed a retrospective analysis of the 127 adult and 77 pediatric cases diagnosed with TBM in the Infectious Disease Hospital of the School of Medicine of Iasi, Romania between 2004-2013.
  
  
  RESULTS
  Definite diagnosis of TBM was established in 31% of children but in only 20% of adults (p = 0.043). A contact with an individual with pulmonary tuberculosis was documented in 30% of children vs. 13% of adults (p = 0.0007). Coma occurred in 19% of patients (similar in children and adults); other consciousness abnormalities were seen in 27% of children and in 72% of adults (p = 0.000001). Cranial nerve palsies occurred prior to therapy in 9% of cases (12% vs 7% of children and adults, respectively, p>0.05), and developed 2-7 days after treatment initiation in 10% (12 vs 9%). CSF cultures were positive for M. tuberculosis in 24% of patients (31% vs. 20%, p>0.05). Overall mortality was 7.35%, similar for children and adults. Yet, permanent neurological sequelae, which were seen in 23% of patients occurred significantly more frequent in children vs. adults (36% vs. 14%, respectively, p = 0.0121). In conclusion, our retrospective analysis on a significant number of cases of TBM identified striking differences between children and adults: while children were in an earlier stage at the admission, they associated a higher frequency of neurological sequelae and miliary pattern, and they were more likely to have normal CSF protein levels and positive cultures of CSF.
authors.affiliation: Department of Infectious Diseases, University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Romania.
authors.forename: Egidia G
authors.initials: EG
authors.lastname: Miftode
authors.affiliation: Department of Microbiology, University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Romania.
authors.forename: Olivia S
authors.initials: OS
authors.lastname: Dorneanu
authors.affiliation: Department of Infectious Diseases, University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Romania.
authors.forename: Daniela A
authors.initials: DA
authors.lastname: Leca
authors.affiliation: Department of Infectious Diseases, University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Romania.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Juganariu
authors.affiliation: Department of Infectious Diseases, University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Romania.
authors.forename: Andra
authors.initials: A
authors.lastname: Teodor
authors.affiliation: Department of Infectious Diseases, University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Romania.
authors.forename: Mihnea
authors.initials: M
authors.lastname: Hurmuzache
authors.affiliation: Department of Infectious Diseases, University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Romania.
authors.forename: Eduard V
authors.initials: EV
authors.lastname: Nastase
authors.affiliation: Department of Pediatrics, University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Romania.
authors.forename: Dana T
authors.initials: DT
authors.lastname: Anton-Paduraru
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D012383:Romania / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D014390:Tuberculosis, Meningeal / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology; D055815:Young Adult