Clinical Spectrum and Presenting Features of Presumptive Tuberculous Meningitis in Children

Open Access

Abstract

Introduction: Tuberculous meningitis (TBM) is a severe childhood tuberculosis that causes serious neurological problems and high death rates in low-resource settings. It is hard to diagnose early because symptoms are nonspecific and tests have low sensitivity with scarce CSF samples. Delays in diagnosis are common and lead to worse outcomes. Objective: This study aimed to describe the demographic, clinical, CSF, and imaging profiles and severity patterns in children with presumptive TBM. Methods & Materials: This descriptive cross-sectional study was carried out at Dhaka Medical College Hospital over one year, involving 96 children aged 1 month to 12 years with suspected TBM. The assessments encompassed clinical examination, GCS scoring, CSF cytology and biochemistry, brain MRI, and chest X-ray. Results: Children under 5 years made up 67.7%, with a mean age of 3.82 years, mostly male (1.5:1) and from rural areas (72.9%). Fever was universal (100%), followed by irritability (55.2%), altered consciousness (44.8%), and convulsions (42.7%). GCS indicated moderate (46.9%) and severe (17.7%) impairment. Severity was related to convulsions (p=0.042), altered consciousness (p=0.001), focal deficits (p=0.008), and neck rigidity (p=0.045). CSF showed lymphocytic dominance, high protein (87.8 mg/dl), and low glucose (51.2 mg/dl). MRI findings included basal enhancement (53.7%), infarcts (14.9%), and hydrocephalus (10.4%). Chest X-ray was normal in 71.9%. Contact history was noted in 17.7%. Only 30.2% were probable TBM, with 69.8% possible. Conclusion: Young males from rural families are at the highest risk. Persistent fever, altered consciousness, and seizures should alert clinicians in endemic areas. The prominence of TBM cases underscores the urgent need for better rapid diagnostics and targeted actions to cut mortality and prevent disabilities.