A study on clinical manifestations and outcome of tuberculous meningitis among children with reference to BCG vaccination status and nutritional status

Srinivasa Arer, Vasundara S. Gayakwad


Background: Childhood tuberculosis is largely underestimated due to diagnostic difficulties and non-specific clinical manifestations, even in many tertiary care hospitals. With increase in coverage of BCG vaccination and improved nutritional status in children, modified clinical pictures of childhood tuberculous meningitis (TBM) has been observed in some research studies. Objectives: To study the different clinical manifestations and outcome of TBM in relation to BCG vaccinated, non- vaccinated and nutritional status of the children, in VIMS Bellary. Methodology: This is a case series prospective study. Patients admitted in the paediatric emergency ward from Nov 2003 to Nov 2004 were recruited for the study. The patients were classified according to their immunization status and nutritional status. Results: TBM constituted 29% of the total admitted TB cases. Majority were below 5 years. Fever, vomiting, positive McEwan’s sign and meningeal irritation signs were the commonest features observed. Atypical features were present in one third of the cases. No significant differences were seen between vaccinated and non-vaccinated patients. Significant differences, however, were observed in the clinical features and mortality between severely malnourished and well-nourished TBM cases in this study. Conclusion: It was concluded that clinical patterns in TBM vary according to nutritional status of the child and severe malnutrition carry very poor prognosis. Knowing different clinical patterns of the disease helps in early prognosis and thus in preventing deaths due to TBM among children.

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Ahmadinejad Z, Ziaee V, Aghsaeifar M, Reiskarami SR. The prognostic factors of tuberculous meningitis. Int J Infect Dis. 2003;3(1).153-4.

Mahadevan S. Advances in diagnosis of tuberculosis. Indian J Pediatr. 1996;63(2):153-7.

Donald PR. Children and tuberculosis: protecting the next generation? Lancet. 1999; 353 (9157): 1001-2. DOI:10. 1016/s0140-6736(99)02010-3

Udani PM. BCG vaccination in India and tuber-culosis in children: newer facets. The Indian Journal of Pediatrics. 1994;61(5):451-62.

Dastur DK, Manghani DK, Udani PM. Pathology and pathogenetic mechanisms in neurotuberculosis. Radio Clin North Am. 1995;33(4):733-52.

Awasthi S, Moin S. Effectiveness of BCG vaccination against tuberculous meningitis. Indian Pediatr. 1999;36 (5):455-60.

Seth V, Gulati S. clinical manifestations, Diagnosis and treatment In; Essentials of tuberculosis in children Ed. Set V. New Delhi; Jaypee Brothers 2003:134-62.

Peter D Corr. Imaging in CNS Tuberculosis Available at www.e-medicine.com/radio/topic 720.

Bernaerts A, Vanhoenacker FM, Parizel PM, Van Goethem JW, Van Altena R, Laridon A, et al. Tuber-culosis of the central nervous system: overview of neuroradiological findings. Eur Radiol. 2003;13(8): 1876-90. Epub 2002. DOI:10.1007/s00330-002-1608-7

Benakappa DG, Chandrasekhar SK, Chandrasekhar P, Kakkur M, Bhargava KM. Tuberculous meningitis: review of 50 cases. Ind Pediat. 1975;12(11):1161.

Chandrashekar- Clinical profile and outcome of tuberculous meningitis in children at district hospital, Bellary. thesis submitted to department of paediatrics VIMS Bellary 1999.

Garg BK. Tuberculous meningitis in children. Ind J Paediat 1981;44(3):87.

Kennedy DH, Fallon RJ. Tuberculous meningitis. JAMA. 1979;241(3):264-8.

Degefie T. Tuberculous meningitis in a district hospital from Southern Ethiopia. Ethiop Med J. 2003;41 (4): 311-8.

Ramachandran RS, Ramanathan K, Indra G. Tuber-culous meningitis. A review of 288 cases in children. Indian J Pediatr. 1970;37(266):85-8.

Kondo S, ITO M. Usefulness of cranial and chest imaging in the diagnosis of tuberculous meningitis among infants and young children. Kekkaku (Tuberculosis). 2003; 78(2):89-93.

Girgis NI, Sultan Y, Farid Z, Mansour MM, Erian MW, Hanna LS et al. The effect of prior BCG vaccination on the clinical and radiographic presentation of tuberculosis meningitis in children in Istanbul, Turkey. Int J Tuberc Lung Dis. 1998;2(11): 885-90.

Girgis NI, Sultan Y, Farid Z, Mansour MM, Erian MW, Hanna LS. et al. Tuberculosis meningitis, Abbassia Fever Hospital-Naval Medical Research Unit No. 3-Cairo, Egypt, from 1976 to 1996. Am J Trop Med Hyg. 1998; 58 (1): 28-34. DOI: 10.4269/ajtmh. 1998.58.28

Al-Abasil AM. Tuberculous meningoencephalitis in Baghdad,1993-99: a clinical study of 224 cases. Eastern Health J. 2002;8(2):3.

Malik ZI, Ishtiaq O, Shah NH, Anwer F, Baqai HZ. Analysis and outcome of 30 patients with tuberculous meningitis. Pak J Med Res. 2002;41(4):137-41.

Kalita J, Misra UK. Outcome of tuberculous meningitis at 6 and 12 months: a multiple regression analysis. Int J Tuberc Lung Dis. 1999;3(3):261-5.

Gupta S, Chopra K. Tuberculous meningitis in children. Ind. J Tub. 1981;28(1):261-5.


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