TUBERCULOUS MENINGITIS (TBM)

AN EXPERIENCE OF 100 PAEDIATRIC PATIENTS

Abstract

OBJECTIVES: To study clinical and diagnostic laboratory features of tuberculous meningitis (TBM)
in children. STUDY DESIGN: Prospective cohort study. PATIENTS & METHODS: Children diagnosed
as TBM in Paediatric ward Allied Hospital, Punjab Medical College Faisalabad were included in the study.
Complete history and clinical examination was recorded. Complete blood count, ESR, Chest X Ray,
Mantoux test were done. CSF was subjected to biochemical and microscopic examination. CT scan
(computerized axial tomogram) of brain, plain and contrast was done in all patients. RESULTS: One
hundred children were included in the study. 67% were below five years of age. 78% belonged to lower
socioeconomic status. 82% were malnourished. 26% were vaccinated while 74% were unvaccinated. History
of contact with a tuberculous patient was found in 48% of patients. 69% were in stage III TBM, 31% in stage
II. 74% had focal neurological deficit with hemiplegia being the commonest one. 73% had convulsions.
Most patients presented quite late, 29% were comatose for more than two weeks before coming to the
hospital . 28% were in decerebrate or decorticate posture. Atypical clinical findings were also noticed. 43%
had high grade fever from the onset of illness, 14% had an abrupt onset with symptoms developing in less
than one week. 39% had encephalitic TBM. 31% had extra pyramidal signs. Mantoux test was >10 mm in
17% cases, suggestive chest X-Ray in 80% and typical CSF findings in 46%. 37% had normal CSF glucose,
8% had predominant polymorphs in CSF. Abnormal CT scan was found in 85% cases with hydrocephalus
as commonest CT abnormality observed. CONCLUSIONS: A high index of suspicion is needed to
diagnosis TBM in children. A combination of epidemiological , clinical and laboratory data should be used
to make an early diagnosis.