Assessment of Clinical Manifestations and Outcome of Tuberculous Meningitis Among Children with Reference to BCG Vaccination Status and Nutritional Status

Abstract

Aim: The objective of the present study was to evaluate the different clinical manifestations and outcome of TBM in relation to BCG vaccinated, non-vaccinated and nutritional status of the children.

Methods: The present study was conducted at department of Pediatrics, RIMS, Ranchi, Jharkhand, India from Feb 2018 to Jan 2019  and 50 children with definite or probable tuberculous meningitis (TBM) were included. Permission for the study was obtained from the College authorities prior to commencement. Duration of the study was one year. Local cultural values and ideas were respected. Confidentiality was assured. The nature and purpose of the survey were explained in detail to them in their own language.

Results: The common symptoms observed were fever 90%, altered sensorium 62%, vomiting 60% and convulsions 56%. Other symptoms observed were cough, headache. The common signs present were GCS below 10 in 57% of cases, meningeal irritation in 64%, and McEvan’s sign in 60%. Also seen were hemiparesis 43%, CN palsy 43%, fundal changes25%. All signs were significantly more common in malnourished children except GCS10-14. Tuberculomas, conscious variety and focal involvements are seen more commonly in well-nourished group among vaccinated patients. All atypical features of TBM are more common in well-nourished group when compared to malnourished children except encephalopathy. Other typical features found were Ophthalmoplegia (3), brain stem syndromes (2), serous meningitis (2), conscious type (3), encephalopathy (2) and focal infarcts in 4 cases.

Conclusion: It was concluded that clinical patterns in TBM vary according to nutritional status of the child and severe malnutrition carry very poor prognosis. Knowing different clinical patterns of the disease helps in early prognosis and thus in preventing deaths due to TBM among children.

Keywords: Tuberculous Meningitis, BCG immunisation status, Severe Malnutrition