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Tuberculous meningitis and miliary tuberculosis in young children
Author(s) -
Bos F.,
Terken M.,
Ypma L.,
Kimpen J. L. L.,
Nel E. D.,
Schaaf H. S.,
Schoeman J. F.,
Donald P. R.
Publication year - 2004
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1046/j.1365-3156.2003.01185.x
Subject(s) - miliary tuberculosis , medicine , tuberculous meningitis , tuberculosis , concomitant , meningitis , cerebrospinal fluid , chest radiograph , pediatrics , mantoux test , radiography , surgery , tuberculin , pathology
Summary Objectives To document the clinical and diagnostic features of tuberculous meningitis (TBM) in young children with and without concomitant miliary tuberculosis (TB). Methods A retrospective comparative study. Results 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 × 10 6 /l and 38 × 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 ≥10 mm ( P = 0.23). Ten children (10%) died, five (7%) who had TBM only and five (16%) who had TBM and miliary TB. Conclusion 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.