Abstract:

Objective To analyze the clinical characteristics and treatment outcome in children with tuberculous meningitis (TBM) and provide reference for the diagnosis and treatment.Methods A retrospective analysis was conducted on the clinical data of 41 pediatric TBM patients admitted to Shenyang Chest Hospital from January 2013 to January 2018. Among 41 cases, 29 cases (70.7%) were rural children, 12 cases (29.3%) were urban children, 8 cases (19.5%) had close contact with pulmonary tuberculosis, 11 cases (26.8%) were diagnosed by Mycobacterium tuberculosis cultured with MGIT 960 or L?wenstein-Jensen medium, and 30 cases (73.2%) were diagnosed as composite reference standard (CRS).Results The main clinical manifestations were fever in 39 cases (95.1%), headache in 34 cases (94.4%, 34/36), vomiting in 27 cases (65.9%), emaciation in 23 cases (56.1%), disturbance of consciousness in 17 cases (41.5%) and convulsions in 8 cases (19.5%). The main clinical signs were neck rigidity in 39 cases (95.1%), Kernig sign positive in 21 cases (51.2%), pupil light reflex insensitive or disappeared in 18 cases (43.9%), tuberculin skin test positive in 22 cases among 37 cases (59.5%), blood tuberculosis infection T cell spot test (T-SPOT.TB) positive in 17 cases among 27 cases (63.0%). Erythrocyte sedimentation rate (ESR) was more than 20 mm/1h in 21 cases among 37 cases (56.8%), C-reactive protein (CRP) was abnormal in 18 cases among 33 cases (54.5%). GeneXpert MTB/RIF was positive in 8 cases among 19 cases (42.1%). The culture of Mycobacterium tuberculosis in cerebrospinal fluid using MGIT 960 was performed in 30 cases, and 11 cases (36.7%) were positive. In 29 cases, 18 cases (62.1%) were abnormal by enhanced MR, of which 9 cases showed tuberculosis nodules and tuberculoma, 5 cases (17.2%) showed tuberculous encephalitis, 16 cases (39.0%) complicated with extracranial tuberculosis, of which secondary pulmonary tuberculosis and tuberculous pleurisy were the most common. There were 22 cases (53.7%) with abnormal liver function and 23 cases (56.1%) with hyperuricemia after chemotherapy. Among 41 cases, 39 cases completed chemotherapy for 18 months including 35 cases (85.4%) showed improvement and 4 cases (9.8%) did not improve, the other 2 cases (4.9%) gave up treatment within 1 week and lost follow-up.Conclusion The clinical manifestations of nervous system in children with TBM are typical. Children can be complicated with extracranial tuberculosis. Laboratory examination is typical in cerebrospinal fluid, the positive rate of GeneXpert MTB/RIF is higher than that of cerebrospinal fluid culture. The skin test of tuberculosis, T-SPOT.TB,ESR and CRP are helpful to diagnosis. The skull imaging examination is not specific. Liver function abnormality and hyperuricemia is more common after chemotherapy, but the prognosis is better.

Key words: Tuberculosis meninges, Children, Diagnostic techniques and procedures, Disease characteristics, Treatment results