We evaluated the clinical and laboratory findings of
tuberculous meningitis admitted to Tokyo Metropolitan Children's Hospital from 1980 through 1991 retrospectively. They consisted of 26 patients (14 boys and 12 girls), and their age ranged from 4 months to 11 years. Seventeen patients were under 3 years of age. Mortality rate was 4% (1/26), and there were 13 patients with sequelae on discharge from the hospital, and 12 patients without any sequelae. The period to recover normal CSF findings was relatively long. Some cases which did not seem to respond well to
chemotherapy at the initial stage, recovered from
meningitis without sequelae. This suggests that it is not necessary to change the
chemotherapy at the initial few weeks of
therapy. The risk factors of poor prognosis were; age less than 2 years, decreased level of consciousness on admission, convulsion, CSF
protein more than 70 mg/dl, and CSF
glucose less than 20 mg/dl.
Tryptophan reaction was not always positive.
Chloride in CSF was not so important to diagnose
tuberculous meningitis in children. For the proper diagnosis of
tuberculous meningitis in children one should consider several factors such as
tuberculin skin test, family history, chest X-ray findings and CSF study. BCG was inoculated in six children (three patients were under one year old and the rests were older than 4 years). In three patients under one year old BCG was seemed to be inoculated after
Mycobacterium tuberculosis infection, and apparently not effective to prevent
tuberculosis meningitis. We conclude that BCG vaccination is necessary in early infancy to prevent
tuberculous meningitis.