TUBERCULOUS
MENINGITIS IN MEXICAN CHILDREN ¨C REPORT OF 512 CASES
Gonzalez SN, Yee AA, Hernandez PM, Macias PM
National Institute of Pediatrics, Mexico City, Mexico
Objective: Review all cases of tuberculous
meningitis in Mexican children seen at the National Institute of Pediatrics
in Mexico City.
Material and Methods: 512 records of patients
with Tuberculous Meningitis (TM) diagnosed following criteria established
by the CDC were reviewed. In all cases age, sex, nutritional condition,
time of course before admission, signs, symptoms, CSF abnormalities, PPD
history, Combe, radiological abnormalities, imaging, PCR, Elisa-TB as well
as sequelae and mortality rates were analyzed.
Results: 512 children with TM were admitted to the
National Institute of Pediatrics from January 1971 to July 2000. Age of our
patients was between 0 and 18 years; with higher incidence between 1 and 4
years. The nutritional condition of most of the children (304 cases) 59.3%
was good, only 80% (15.6%) had 3rd degree malnutrition. The most
common clinical findings were: impaired mental condition, fever, mape
stiffness, vomiting and drowsiness. Only 16 children (3.1%) were in coma on
admission. Involvement of cranial nerves was found in 325 children (63.4%).
312 cases (61%) had a time of course before admission greater than 28 days,
196 (38.3%) had a PPD (+) and Combe (+). PCR in CSF showed 100% sensitivity
and 61% specificity. In 324 cases (63%) chest X-rays showed abnormalities.
436 cases (85%) showed CT abnormalities with basal arachnioditis as the
most common finding. 400 patients (78%) presented sepuelae. From the total
number of patients, 24 (4.7%) died.
Conclusions: TM is still a public health problem in
developing countries. The diagnosis is essentially established using clinical
findings, radiology and imaging (CAT scan) and CSF findings. Nevertheless,
the diagnosis is still made late, making prognosis poor.