Tubercular meningitis in children: Clinical, pathological, and radiological profile and factors associated with mortality.

CONTEXT

Childhood tuberculosis is a major public health problem in developing countries with tubercular meningitis being a serious complication with high mortality and morbidity.

AIM

To study the clinicopathological as well as radiological profile of childhood tuberculous meningitis (TBM) cases.

SETTINGS AND DESIGN

Prospective, observational study including children <14 years of age with TBM admitted in a tertiary care hospital from Western India.

SUBJECTS AND METHODS

TBM was diagnosed based on predefined criteria. Glassgow coma scale (GCS) and intracranial pressure (ICP) was recorded. Staging was done as per British Medical Council Staging System. Mantoux test, chest X-ray, cerebrospinal fluid (CSF) examination, neuroimaging, and other investigations were done to confirm TB.

STATISTICAL ANALYSIS USED

STATA software (version 9.0) was used for data analysis. Various risk factors were determined using Chi-square tests, and a P< 0.05 was considered significant.

RESULTS

Forty-seven children were included, of which 11 (24.3%) died. Fever was the most common presenting symptom, and meningismus was the most common sign. Twenty-nine (62%) children presented with Stage III disease. Stage III disease, low GCS, and raised ICP were predictors of mortality. Findings on neuroimaging or CSF examination did not predict mortality.

CONCLUSIONS

Childhood TBM presents with nonspecific clinical features. Stage III disease, low GCS, lack of Bacillus Calmette-Guérin vaccination at birth and raised ICP seem to the most important adverse prognostic factors.