Main Article Content
Background Tuberculous meningitis is a severe extrapulmonary complication of tuberculosis, with high morbidity and mortality rates.
Objective To assess the relationship between presenting clinical characteristics and outcomes of pediatric tuberculous meningitis.
Methods We present a case review study of all children diagnosed with tuberculous meningitis in Cipto Mangunkusumo Hospital, Jakarta between January 1998 and December 2004. We compared demographic, clinical, and diagnostic characteristics to clinical outcomes.
Results We included 43 patients. Common characteristics on admission were young age (mean 3.2 years), stage II and III tuberculous meningitis (91%), and neurological symptoms existing for more than 1 week, including convulsions (52%), unconsciousness (23%), meningeal irritation (56%), and cranial nerve palsy (67%). A common feature of tuberculous meningitis on computed tomography scan of the brain was hydrocephalus in 19/24 cases. Clinical outcomes were neurological sequelae (88%) and death (12%). Factors associated with poor outcome in univariate analyses were young age, as well as stage II and III tuberculous meningitis.
Conclusions Tuberculous meningitis starts with nonspecific symptoms and is often only diagnosed when brain damage has already occurred. Outcome is directly associated with age and the stage of tuberculous meningitis. Earlier diagnosis may significantly improve outcomes. [Paediatr Indones. 2011;51:288-93].
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
2. Van Well GT, Paes BF, Terwee CB, Springer P, Roord JJ, Donald PR, et al. Twenty years of pediatric tuberculous meningitis: a retrospective cohort study in the western cape of South Africa. Pediatrics. 2009;123:e1-8.
3. Ozek E, Iplkcioglu AC, Erdal M. Intradural extramedullary tuberculoma mimicking enplaque meningioma. Neurol India. 2009;57:211-2.
4. Arulprakash S, Verma SP, Bhardwaj VK, Mishra SS, Chansoria M. Brain stem auditory evoked responses and visual evoked responses in children with tubercular meningitis. Indian Pediatr. 2006;43:631-4.
5. Moon S, Son J, Chang W. A case of oculomotor nerve palsy and choroidal tuberculous granuloma associated with tuberculous meningoencephalitis. Korean J Ophthalmol. 2008;22:201-4.
6. Roca B, Tornador N, Tornador E. Presentation and outcome of tuberculous meningitis in adults in the province of Castellon, Spain: a retrospective study. Epidemiol Infect. 2008;136:1455-62.
7. Chapp-Jumbo EN. Neurologic infections in a Nigerian university teaching hospital. Afr Health Sci. 2006;6:55-8.
8. Haldar S, Sharma N, Gupta VK, Tyagi JS. Efficient diagnosis of tuberculous meningitis by detection of Mycobacterium tuberculosis DNA in cerebrospinal fluid filtrates using PCR. J Med Microbiol. 2009;58:616-24.
9. Thomas MM, Hinks TS, Raghuraman S, Ramalingam N, Ernst M, Nau R, et al. Rapid diagnosis of Mycobacterium tuberculosis meningitis by enumeration of cerebrospinal fluid antigen-specific T-cells. Int J Tuberc Lung Dis. 2008;12:651-7.
10. Quan C, Lu CZ, Qiao J, Xiao BG, Li X. Comparative evaluation of early diagnosis of tuberculous meningitis by different assays. J Clin Microbiol. 2006;44:3160-6.
11. Täuber MG, Schaad UB. Bacterial infections of the nervous system. In: Swaiman KF, Ashwal S, Ferriero DM, editors. Pediatric neurology principles & practice. 4th ed. Philadelphia: Mosby Inc; 2006. p. 1571-95.
12. Rajshekhar V. Management of hydrocephalus in patients with tuberculous meningitis. Neurol India. 2009;57:368-74.
13. Clark M, Cameron DW. The benefits and risks of bacille Calmette-Guérin vaccination among infants at high risk for both tuberculosis and severe combined immunodeficiency: assessment by Markov model. BMC Pediatr. 2006;6:5.
14. Walker V, Selby G, Wacogne I. Does neonatal BCG vaccination protect against tuberculous meningitis? Arch Dis Child. 2006;91:789-91.
15. Sterling TR, Martire T, de Almeida AS, Ding L, Greenberg DE, Moreira LA, et al. Immune function in young children with previous pulmonary or milliary/meningeal tuberculosis and impact of BCG vaccination. Pediatrics. 2007;120:e912-21.
16. Anjay MA, Anoop P. Tuberculous meningitis: more evidence for protective effect of BCG. Arch Dis Child. 2007;92:277.
17. Vinnard C, Winston CA, Wileyto EP, MacGregor RR, Bisson GP. Isoniazid resistance and death in patients with tuberculous meningitis: retrospective cohort study. BMJ. 2010;341:c4451.
18. Nguyen TH, Tran TH, Thwaites G, Ly VC, Dinh XS, Ho Dang TN, et al. Dexamethasone in Vietnamese adolescents and adults with bacterial meningitis. N Engl J Med. 2007;357:2431-40.
19. Iliyasu Z, Babashani M. Prevalence and predictors of tuberculosis coinfection among HIV-seropositive patients attending the Aminu Kano Teaching Hospital, northern Nigeria. J Epidemiol. 2009;19:81-7.