Tuberculous meningitis continues to be a health problem in our country. Although a significant decrease in tuberculosis cases has been reported in our country in recent years, it is noteworthy that there has been a change in childhood tuberculosis meningitis cases. Tuberculosis infection or disease in a child shows us that this infection was recently acquired from the community. When the 2012 tuberculosis dispensary data were examined, 29 cases were seen in the childhood age group in 2002, and this number increased to 36 in 2009. When the data are examined, it is seen that tuberculosis meningitis occurs mainly in 0-5 years of age. From another perspective, it is important that there is no decrease in tuberculosis meningitis cases in children, unlike the reported decrease in tuberculosis cases in adults.
Clinical findings in children with tuberculosis meningitis are examined in three stages.
1- Stage lasts from 2 to 3 weeks. Weakness, fatigue, headache, low fever and personality change are observed.
2- Stage Meningitis symptoms and neurological symptoms appear. Headache, vomiting, seizures, and nerve paralysis are observed.
3- Stage is the period when paralysis develops. The clinical picture progresses rapidly, confusion and coma are observed.
The lack of specificity of the symptoms in the first stage causes the diagnosis of tuberculosis to be ignored.
Examination of the cerebrospinal fluid is important in early stage tuberculous meningitis. Diagnosis is made by demonstrating and producing the tuberculosis microbe. Since these tests are difficult and time-consuming, auxiliary laboratory tests are used to make a diagnosis and start treatment. Nucleic acid tests performed by the PCR method help with early detection. Other tests that help in diagnosis are radiological examinations. Chest X-ray, Cranial CT and especially Cranial MRI are important in diagnosis.
The earlier the treatment is started in cases of tuberculous meningitis, the more satisfactory the outcome. The treatment period lasts 7 to 10 months, depending on the clinical condition of the patient. In necessary cases, surgical treatment can be used in addition to drug treatment.
Tuberculosis (BCG) vaccine is very important in preventing tuberculosis meningitis. Contrary to the discussions about the protection of the tuberculosis vaccine. It is known that children who are vaccinated against tuberculosis are protected from tuberculosis meningitis. Considering that childhood tuberculosis meningitis is most common between the ages of 1-5, it is important to identify and treat adults with tuberculosis who transmit the infection to children. Tuberculous meningitis in childhood is very severe and causes lifelong sequelae. It is obvious that these cases need to be treated meticulously and followed up.
Meningitis in children Dr. Nuran Gürses
Pediatric and Pediatric Infectious Diseases Specialist
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