Hina Ayesha, Farhan Javed.
Tuberculosis Meningitis (TBM); An experience of 100 pediatric patients.
Professional Med J Jan ;9(1):65-70.

OBJECTIVES: To study clinical and diagnostic laboratory features of tuberculosis meningitis (TBM) in children. STUDY DESIGN: Prospective cohort study. PATIENTS & METHODS: Children diagnosed as TBM in Pediatric 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 was 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 tuberculosis 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.

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