The Clinical Analysis Of358Children With Tuberculous Meningitis

Objective:To summarize the clinical characteristics of tuberculous meningitis (TBM) in children, let medical staff know more about the tuberculous meningitis of children, improve the diagnostic level of TBM and reduce misdiagnosis. Methods:A retrospective study was conducted, comprising358children diagnosed TBM in the affiliated children’s hospital of Chongqing medical university from2006-2010. Medical records were reviewed satisfying a standardized protocol. Results:(1) In all cases of TBM,60%of them come from the countryside and56.1%children of tuberculous meningitis are less than5years old, including10.1%less than6months,11.5%aged6months old to1years old,21.8%aged1to2years old.(2)138children (40.0%) have tuberculosis contact history,47.7%in young infants.(3)45.3%children were not vaccinated with BCG or vaccinated without a BCG scar. The vaccinated children with TBM had significantly better outcome than the unvaccinated children.(4) The main early symptoms as chief complaint of TBM are fever, headache, cough, vomiting and convulsion.(5) The first biochemical analyses of cerebrospinal fluid (CSF) have the typical changes among48%patients of TBM.(6) Lumbar puncture was performed on302children,33%of these specimens had a positive CSF culture for mycobacteria and30.3%were smear positive for acid-fast bacilli.(7) The positive rate of head CT and MRI are88.9%and89.2%. The main radiological changes of TBM are hydrocephalus, the basal ganglia and brain parenchyma lesion. There are not significant radiological difference in the positive of TBM between CT and MRI.(8) The prognosis is correlated with the age, the clinical stages, using the glucocorticoid and the intra-thecal injection. Conclusion:(1) The most common manifestations of TBM are fever, intracranial hypertension, convulsion and meningeal irritation signs.(2)The most patients suffered from TBM are children aged less than3years old. The inoculation history of BCG and the tuberculosis contact history should be paid more attention to diagnosing TBM of children, especially for the younger infants.(3) The children suspected TBM should perform lumbar puncture and cranial CT or MRI scans as early as possible. Chest X-ray or CT is also the important clues for TBM.(4) Children with TBM who have rapid diagnosis and initiation of treatment appear to maintain better mentation and have a superior outcome.