CLINICAL AND PUBLIC-HEALTH ASPECTS OF TUBERCULOUS MENINGITIS IN CHILDREN

To define the clinical and public health aspects of tuberculous mening itis, we conducted a 10-year retrospective review of patients with cen tral nervous system (CNS) tuberculosis, investigated health department records of contact investigations involving our patients, and assesse d prospective follow-up of patients, Thirty-one cases of CNS tuberculo sis (8.6% of ail pediatric patients with tuberculosis) were reviewed, Three patients had tuberculomas, 23 had meningitis, and five had both, Cranial nerve involvement, basilar meningitis, and hydrocephalus were common clinical and radiographic findings. Sixty-eight percent had be en examined by a physician in the preceding month, and 13% had been ho spitalized, Symptoms related to tuberculosis averaged 17 days before a dmission: For 15 patients (47%) there was no initial family history of tuberculosis, but an adult with tuberculosis was discovered after the child's symptoms became evident, Tuberculosis had been diagnosed in a n adult in close contact with nine of the patients (38%) before the ch ild became ill, Fight of these adult source cases already had been rep orted to the health department, and more rapid examination of contacts may have prevented meningeal tuberculosis in the child, The diagnosis of CNS tuberculosis should be considered in all children with neurolo gic signs and symptoms of, and risk factors for, tuberculosis.