Tuberculous meningitis in a district hospital from Southern Ethiopia

Abstract

In order to describe the clinical presentation, immediate outcome and risk factors associated with Tuberculous meningitis (TBM), 28 children with TBM were analyzed. The male to female ratio was 1.5:1. The mean age of the cases was 8 years (range 5 months-14 years). Nineteen (67%) of the patients were not vaccinated for Tuberculosis (TB). Nineteen (67%) patients had exposure to adults with pulmonary TB of which 14 (50%) were family members. Among these were four children who were vaccinated and their age range was from 7 month to 8 years. Thirteen (40%) were seen by health professionals with in three months before symptoms related to TBM, the mean duration of symptoms before seeking medical advice was 3.2 months. Using the weight height percentage of median, sixteen (57%) had malnutrition. Twenty (71%) patients were in stage three of TBM at presentation. Eleven (38%) had positive reaction to Mantoux test and 25 (89%) had abnormal chest radiography the most common finding being hilar lymphadenopathy. CSF (Cerebro Spinal Fluid) total cell count showed pleocytosis of < 200 in all but two cases (71%), and raised protein level on quantitative determination. Acid Fast Bacilli (AFB) test done in seven patients, was positive in two (29%) cases. One (4%) direct sputum smear and gastric aspirate culture were positive. Thirteen 13 (46%) patients died despite treatment and 9 (64%) had severe neurological complications. Delay at presentation advanced stage of TBM and unvaccinated state for tuberculosis were closely associated with poor outcome (P<0.05). Hence health workers who treat children should maintain high index of suspicion at all times and evaluate for TBM. The value of prophylaxis for children who have close contact with infectious cases should be evaluated in Ethiopia.