Clinical Study Of Tuberculous Meningitis In170Cases Of Children

Objective:To summarize the clinical features of tuberculous meningitisin the children, and to improve early diagnosis and treatment.Methods:170cases of tuberculous meningitis in our hospital from Jan.2008to Dec.2010were retrospectively analyzed.Results:In all cases,There were170children,including110boys and60girls.The incidence ages were between1month old and16yearsold,among them,there were67cases less than or equal to3years old,about39%.46cases (27%) had clear contact history of tuberculosis, including26cases less than or equal to3years old.161cases (95%) combined with TBsymptoms,162cases (95%) combined with neurological symptoms andsigns. The abnormal rates tested by chest X rays,cranial CT scan and MRIwere78%,90%and89%,respectively.The abnormal rates of cerebrospinalfluid routine and biochemical tests were143cases (90%) and146cases(92%),respectively.71out of159cases had etiological evidence inpathological examination, the positive rate was45%,51cases (32%) weresmear positive for acid fast bacilli,39cases (26%) were positive for CSFmycobacterium tuberculosis culture. As high as39%children up to3years old had contact history of tuberculosis.Fever and cough were the mainclinical performance in the children up to3years old,there were67cases(100%) and38cases (56%),respectively. The positive rates ofcerebrospinal fluid routine and biochemical tests were93%and90%,respectively;the positive rates of CSF smear and mycobacteriumtuberculosis were24%and17%,respectively.The positive rate of chest Xrays in children up to3years old was as high as86%.Conclusion: Boys are more than girls in children with TBM. Childrenless than or equal to3years old accounted for a bigger part in the age ofonset. The clear contact history of tuberculosis was an important evidencebase for the diagnosis of tuberculous meningitis in children,especially forchildren less than or equal to3years old. The clinical manifestations of thevast majority of tuberculous meningitis were TB symptoms,neurologicalsymptoms and signs. The rates of imaging tests and CSF examinationschanges were high, conduce to diagnose.The tuberculous meningitis inchildren up to3years old had acute onset,progress fast and had a higherincidence of fever and cough;the increasing pressure in the brain was notobvious;the positive rate of chest X rays was higher. Children withtuberculous meningitis had complex manifestations,the keys to increase thecure rate and reduce mortality were early diagnosis and regularantitubercular treatment.