Evaluation of patients with tuberculous meningitis

Abstract

Objective: Tuberculous meningitis is a form of extrapulmonary tuberculosis which has the highest mortality and morbidity rate. The aim of this study is to evaluate clinical signs and treatment regimens of patients with tuberculous meningitis.Material and Methods: Epidemiological properties, clinical signs, treatment regimens and prognosis of 11 patients with tuberculous meningitis in the Uludag University Medical Faculty Pediatric Infectious Disease Department between 2005- 2010 were evaluated.Results: Of the patients, 81.8% were boys with a mean age of 5.15 +/- 1.69 years (2 months- 15 years). The patients < 1year made up 36.3%. The most frequent complaints were fever and drowsiness in 45.5%, headache, nausea, vomiting in 18.2%, drowsiness in 18.2%. Physical examinations revealed fever and drowsiness in 63.6% and neck stiffness in 36.4%. Four patients (36.4%) had a person with active tuberculosis in his/her family. Tuberculin skin test (TST) was applied to all patients and resulted in > 15 mm enduration in 45.5%. BCG scarring was present in 72.7% of patients. Acid- alcohol- resistant bacillus (AARB) was seen in the cerebrospinal fluid (CSF) of 18.2% patients and grew Mycobacterium tuberculosis complex in cultures. Average cell count in CSF was 130 +/- 54.4, 75% lymphocyte in giemza staining. Average CSF protein 173.3 +/- 23.5 mg/dL, CSF chlorine 109.3 +/- 4.1mEq/L, CSF LDH 390.2 +/- 331.1 IU/L were found. Of the patients, 9.1% were in stage 1, 45.5% in stage 2 and 45.5% in stage 3 on admission. Cranial MRI revealed hydrocephaly + leptomeningeal staining in 45.5%, tuberculoma+ leptomeningeal staining in 18.2%, leptomeningeal staining in 27.3% and hydrocephaly in 9.1%. Of the patients, 81.8% were treated with izoniazid, rifampicin, pyrazinamid and streptomycine or ethambutole for two months initially, with izoniazid, rifampicin during the following 10 months. Prednisolone at 2 mg/kg/day was given to patients. Ventriculoperitoneal shunt was placed in 36.4% of patients for hydrocephalus. Neurological sequelae developed in 72.7% of patients. Of all the patients, 36.4% had mental- motor retardation, 27.3% learning difficulties and 9.1% hearing loss. One patient (9.1%) died.Conclusion: Because tuberculous meningitis is an infectious disease with high mortality and morbidity rates in childhood, rapid diagnosis and treatment is necessary for reducing complications.