Therapeutic Advances in Infectious Disease (Sep 2024)

Clinical and diagnostic features of central nervous system tuberculosis in Indian children – a descriptive study

  • Bella Devaleenal Daniel,
  • Elilarasi Selladurai,
  • Sarath Balaji,
  • Arunagirinathan Venkatesan,
  • Mythily Venkatesan,
  • Prathiksha Giridharan,
  • Sivakumar Shanmugam,
  • Saravanan Natrajan,
  • Ramesh Karunaianantham,
  • Devika Kandasamy,
  • Rajakumar Subramani,
  • Kannan Muthuramalingam,
  • Snegha K. Pramila,
  • Syed Hissar,
  • Kelly E. Dooley,
  • Kiran T. Thakur

DOI
https://doi.org/10.1177/20499361241274251
Journal volume & issue
Vol. 11

Abstract

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Background: Children with tuberculous meningitis (TBM) present with diagnostic challenges as they often have atypical clinical features. Objective: To describe the baseline characteristic features of children diagnosed with central nervous system (CNS) TB (TBM and tuberculoma). Design: Retrospective descriptive study. Methods: Children less than 12 years presenting with neurological signs and symptoms were assessed for a therapeutic TBM trial eligibility. The results of their clinical, laboratory, neuroimaging, cerebrospinal fluid evaluations were analysed for TBM diagnosis. Results: Of 600 children evaluated, 61(10%) had CNS tuberculosis; TBM 47, tuberculoma 14. 20(33%) had definite TBM. Mean age of children with TBM was 5 ± 3.4 years. Of 47, 13(28%), 21(45%) and 13(28%) had grade I, II, and III disease respectively. Abnormalities suggestive of TBM in MRI and computed tomography brain were observed in 76% (26/34) and 77% (24/31) respectively. Abnormal cerebrospinal fluid white blood cell count, protein and glucose were observed in 56% (24/43), 49% (22/45), 47% (21/45) respectively. Among 41 patients with TBM followed up until discharge, five died. Conclusion: Younger children with TBM have severe forms. Confirmatory results may not be available in all. A holistic approach to care including addressing complications of hydrocephalus and strokes is needed.