title: Tubercular meningitis in children: Clinical, pathological, and radiological profile and factors associated with mortality.
abstract: BACKGROUND
  Childhood tuberculosis is a major public health problem in developing countries with tubercular meningitis being a serious complication with high mortality and morbidity.
  
  
  OBJECTIVE
  To study the clinicopathological as well as radiological profile of childhood tuberculous meningitis (TBM) cases.
  
  
  METHODS
  Prospective, observational study including children <14 years of age with TBM admitted in a tertiary care hospital from Western India.
  
  
  METHODS
  TBM was diagnosed based on predefined criteria. Glassgow coma scale (GCS) and intracranial pressure (ICP) was recorded. Staging was done as per British Medical Council Staging System. Mantoux test, chest X-ray, cerebrospinal fluid (CSF) examination, neuroimaging, and other investigations were done to confirm TB.
  
  
  METHODS
  STATA software (version 9.0) was used for data analysis. Various risk factors were determined using Chi-square tests, and a P< 0.05 was considered significant.
  
  
  RESULTS
  Forty-seven children were included, of which 11 (24.3%) died. Fever was the most common presenting symptom, and meningismus was the most common sign. Twenty-nine (62%) children presented with Stage III disease. Stage III disease, low GCS, and raised ICP were predictors of mortality. Findings on neuroimaging or CSF examination did not predict mortality.
  
  
  CONCLUSIONS
  Childhood TBM presents with nonspecific clinical features. Stage III disease, low GCS, lack of Bacillus Calmette-Guérin vaccination at birth and raised ICP seem to the most important adverse prognostic factors.
authors.affiliation: Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Anil V
authors.initials: AV
authors.lastname: Israni
authors.affiliation: Department of Pediatrics, Medical College Baroda and SSG Hospital, Vadodara, Gujarat, India.
authors.forename: Divya A
authors.initials: DA
authors.lastname: Dave
authors.affiliation: Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Anirban
authors.initials: A
authors.lastname: Mandal
authors.affiliation: Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, New Delhi, India.
authors.forename: Amitabh
authors.initials: A
authors.lastname: Singh
authors.affiliation: Department of Pediatrics, Kalawati Saran Children Hospital, New Delhi, India.
authors.forename: Puneet K
authors.initials: PK
authors.lastname: Sahi
authors.affiliation: Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.
authors.forename: Rashmi Ranjan
authors.initials: RR
authors.lastname: Das
authors.affiliation: Department of Pathology, Toprani Advanced Lab Systems, Vadodara, Gujarat, India.
authors.forename: Arpita
authors.initials: A
authors.lastname: Shah
keywords: Children; developing country; meningitis; mortality; tuberculosis