In this study we reviewed M. tuberculosis meningitis (TBM) cases in childhood at our unit in a five-year period.
Methods: Included in this retrospective study were children admitted to Cotugno Hospital from 1995 to 1999 who fulfilled criteria for a TBM diagnosis. Medical records were analyzed for epidemiological data, clinical manifestations, laboratory test results, radiological investigations and clinical outcome.
Results: We identified 10 children with TBM. Family history of tuberculosis (TB) was observed in 6 patients. Fever preceded hospital admission of 4-60 days (median 8 days); neurological signs were present 1-6 days before admission in 8 patients. All patients showed a predominance of lymphocytes, elevated proteins and reduced glucose concentration in cerebrospinal fluid (CSF). Mycobacterium tuberculosis was either cultured or identified by acid fast stain in 5 patients. Cranial CT-scans and MRI showed hydrocephalus in 8 patients and ring-enhancing lesions in 6. Antituberculous therapy was administered according to current recommendations for at least 12 months, with a 4-6 week steroid therapy course. Two patients had permanent neurological sequelae.
Conclusions: Careful evaluation of symptoms and CSF findings is the only way to establish an early diagnosis and reduce sequelae.