van den Bos F, Terken M, Ypma L, Kimpen J L L, Nel E D, Schaaf H S, Schoeman J F, Donald P R
Utrecht University Medical Center, Utrecht, The Netherlands.
Trop Med Int Health. 2004 Feb;9(2):309-13. doi: 10.1046/j.1365-3156.2003.01185.x.
To document the clinical and diagnostic features of tuberculous meningitis (TBM) in young children with and without concomitant miliary tuberculosis (TB).
A retrospective comparative study.
Of 104 children with TBM, 32 (31%), median age 17.0 months, had a miliary appearance on chest radiograph; 72 (69%), median age 30.5 months, had TBM only (P = 0.04). Mediastinal adenopathy was noted in 27 (84%) of the children with miliary TB and 33 (46%) of those with TBM only (P = 0.0005). The mean cerebrospinal fluid (CSF) lymphocyte and polymorphonuclear counts of all children (no significant differences between groups) were 137 x 10(6)/l and 38 x 10(6)/l and the mean protein and glucose concentrations were 1.45 g/l and 0.72 mmol/l, respectively. Polymorphonuclear leukocytes were predominant in the CSF of 17% of children, in 16% the CSF glucose was > 2.2 mmol/l and in 26% the CSF protein was < 0.8 g/l. On Mantoux testing 37 (65%) of 57 children with TBM only and 12 (48%) of 25 children with TBM and miliary TB had an induration of > or = 10 mm (P = 0.23). Ten children (10%) died, five (7%) who had TBM only and five (16%) who had TBM and miliary TB.
Children with TBM and miliary TB were younger and more likely to have mediastinal adenopathy on chest radiography than those with TBM only. Diagnostic features and investigations in both groups may be misleading at times.
记录合并和未合并粟粒型肺结核（TB）的幼儿结核性脑膜炎（TBM）的临床和诊断特征。
一项回顾性对照研究。
104例TBM患儿中，32例（31%）胸部X线片呈粟粒样表现，中位年龄17.0个月；72例（69%）仅患TBM，中位年龄30.5个月（P = 0.04）。粟粒型TB患儿中有27例（84%）发现纵隔淋巴结肿大，仅患TBM的患儿中有33例（46%）出现此情况（P = 0.0005）。所有患儿脑脊液（CSF）淋巴细胞和多形核细胞计数的均值（两组间无显著差异）分别为137×10⁶/L和38×10⁶/L，蛋白和葡萄糖浓度均值分别为1.45 g/L和0.72 mmol/L。17%的患儿CSF中多形核白细胞占优势，16%的患儿CSF葡萄糖>2.2 mmol/L，26%的患儿CSF蛋白<0.8 g/L。结核菌素试验中，仅患TBM的57例患儿中有37例（65%）硬结直径≥10 mm，合并粟粒型TB的25例患儿中有12例（48%）硬结直径≥10 mm（P = 0.23）。10例患儿（10%）死亡，仅患TBM的5例（7%），合并粟粒型TB的5例（16%）。
与仅患TBM的患儿相比，合并粟粒型TB的TBM患儿年龄更小，胸部X线片更易出现纵隔淋巴结肿大。两组的诊断特征和检查有时可能会产生误导。
