Tuberculosis infantil en Chile: ¿de dónde provienen los casos? / Childhood tuberculosis in Chile: where do the cases come from?

La tuberculosis es la principal causa de muerte por un agente infeccioso a nivel mundial y se estima que un 6% de los casos nuevos corresponde a tuberculosis infantil. La presencia de tuberculosis en niños es una señal de la existencia de transmisión del agente en la comunidad. Esta investigación busca describir las características epidemiológicas de la tuberculosis infantil en Chile entre 2011 y 2020. METODOLOGÍA: estudio descriptivo de los casos de tuberculosis infantil registrados en Chile entre los años 2011 y 2020. RESULTADOS: se registraron 544 casos de tuberculosis en menores de 15 años en el período analizado, con una tasa de incidencia anual entre 1,1 y 2,2 casos por 100.000. Se observa un importante aumento de casos en los últimos tres años, especialmente en el grupo de menores de 5 años. 63,2% corresponden a tuberculosis pulmonar, y de ellos 62,3% fueron confirmados por bacteriología. La mayoría de los casos no presenta comorbilidades que impliquen inmunosupresión y la incidencia de meningitis tuberculosa en menores de 5 años es baja. La proporción de contactos es de 29% y la de extranjeros de 17%, ambas variables en aumento en los últimos años. CONCLUSIÓN: La tuberculosis en niños sigue siendo un problema de salud poco frecuente en Chile. Sin embargo, su aumento en los últimos años debe alertar sobre un incremento de la transmisión comunitaria de la enfermedad, por lo que se debe reforzar la detección oportuna de casos contagiantes, la investigación de contactos y el tratamiento preventivo.

Tuberculosis is the leading cause of death from a single infectious agent worldwide and it is estimated that 6% of new cases are children. Childhood tuberculosis reflects ongoing transmission within communities. This study aims to describe the epidemiological characteristics of childhood tuberculosis in Chile between 2011 and 2020. METHODOLOGY: descriptive study of the cases of tuberculosis under 15 years-old registered in Chile from 2011 to 2020. RESULTS: 544 cases were registered in the period analyzed, with an annual incidence rate between 1.1 and 2.2 cases per 100,000. A significant increase in cases is observed in the last three years, especially in the group under 5 years-old. 63.2% correspond to pulmonary tuberculosis, and among them 62.3% are confirmed by bacteriology. Most of the cases do not have comorbidities and the incidence of tuberculous meningitis in children under 5 years is low. Contacts are 29% of the cases and foreigners are 17%, both percentages are increasing in the last years. CONCLUSION: Childhood tuberculosis remains a low frequency health problem in Chile. However, its increase in recent years implies an increase in the community transmission. Active case finding, contact tracing and preventive treatment should be reinforced.

Tuberculosis meníngea: reporte de casos años 2005-2017 / Meningeal tuberculosis: cases report years 2005-2017

INTRODUCCIÓN: La tuberculosis (TBC) continúa siendo un problema de salud pública mundial; su forma meníngea conlleva mayor letalidad y secuelas, en particular si se asocia a la infección por VIH/SIDA. OBJETIVO: Describir las características demográficas, presentación clínica, laboratorio y de las imágenes de los pacientes con TBC meníngea (aislamiento de Mycobacterium tuberculosis en LCR), analizando diferencias entre pacientes con y sin infección por VIH/SIDA. PACIENTES Y MÉTODOS: Estudio observacional y descriptivo, retrospectivo, de una serie de casos atendidos en el Hospital Dr. Alejandro Posadas de Buenos Aires, Argentina, desde enero de 2005 hasta diciembre de 2017. RESULTADOS: Se analizaron 36 pacientes, 22 de ellos mujeres, con una mediana de edad de 36,5 años. Veintidós pacientes presentaron co-infección por VIH, todos en estadio SIDA. El tiempo de inicio de síntomas tuvo una mediana 11 días. predominando fiebre, estado de conciencia alterado y cefalea. En el LCR se hallaron linfocitosis, hipoglucorraquia, hiperproteinorraquia y ácido láctico elevado. Se realizó tomografía computada de encéfalo a 34 pacientes, 16 sin alteraciones. En otros 16 se realizó resonancia magnética (RM) cerebral, 9 presentaban trastornos vasculares. La RM fue más sensible para identificar refuerzo meníngeo, trastornos de tipo vasculares, y lesiones de tipo granulomatosas. La mediana de inicio de tratamiento fue de 1 día, con 72,2% recibiendo co-adyuvancia con corticosteroides. La mortalidad observada fue de 27,7% y secuelas hubo en 36,1%. Sólo 5 pacientes requirieron intervención neuro-quirúrgica. CONCLUSIÓN: Siendo la TBC meníngea una afección de alta morbimortalidad, es imperioso asegurar un diagnóstico temprano en su evolución mediante la incorporación de la biología molecular e imagenología (RM) al amplio uso clínico.

BACKGROUND. Tuberculosis (TB) continues to be a global public health problem; its meningeal form leads to greater lethality and sequelae, particularly if it is associated with HIV / AIDS infection. AIM: To describe the demographic characteristics, clinical presentation, laboratory and images of patients with meningeal TB (isolation of Mycobacterium tuberculosis in CSF), analyzing differences between HIV and non-HIV patients. METHODS: We performed an observational and descriptive study, with retrospective analysis of patients attending at the Dr. Alejandro Posadas Hospital, Buenos Aires, since January 2005 to December 2017. RESULTS: Thirty-six patients were analyzed, with 22 women with a median age of 36.5 years. Twenty two patients had HIV coinfection, all in the AIDS stage. The symptom onset time was median 11 days. The predominant ones were fever, altered consciousness and headache. In the cerebrospinal fluid were lymphocitosis, hypoglycorrhachia, hyperproteinorrhachia and high lactic acid, according to previously described findings. Of 34 patients who underwent brain scan, 16 patients had no significant pathological findings. MRI was performed in 16 patients, 9 had vascular disorders. Brain MRI was more sensitive to identify meningeal reinforcement than computerized tomography, vascular disorders, and granulomatous lesions. The median onset of treatment was 1 day, with 72.2% of the total receiving coadjuvants with corticosteroids. Mortality of 27.7% and sequelae in 36.1% were observed. Only 5 patients required neurosurgical intervention. CONCLUSION: Since meningeal TB is a disease with high morbidity and mortality, it is imperative to ensure an early diagnosis in its evolution by incorporating molecular biology and imaging (MRI) into broad clinical use.

Incidence of tuberculous meningitis in the State of Santa Catarina, Brazil

Introduction The aim of this study was to estimate the incidence of tuberculous meningitis in the State of Santa Catarina (SC), Brazil, during the period from 2001 to 2010. Methods Ecological, temporal, and descriptive methods were employed using data obtained from the Information System on Disease Notification (Sistema de Informação de Agravos de Notificação). Results One hundred sixteen reported cases of tuberculous meningitis occurred from 2001 to 2010, corresponding to 1.2% (0.2 cases/100,000 inhabitants) of all meningitis cases reported in SC. There was a predominance of new cases in males, corresponding to 56.9% of new cases (0.2 cases/100,000 inhabitants; males vs. females; p=0.374), in patients aged 20-39 years, corresponding to 52.6% of new cases (0.5 cases/100,000 inhabitants; 20-39 years versus others; p<0.001), and in urban areas, corresponding to 91.4% of new cases (0.2 cases/100,000 inhabitants; urban vs. rural; p=0.003). In 48.3% of cases, the outcome was death. Conclusions The incidence rate of tuberculous meningitis in SC has increased within the last decade, with the most affected population comprising young adult white males with an average education. Thus, tuberculous meningitis remains a serious disease, emphasizing the need for disease prevention with vaccination campaigns against tuberculosis, the development of faster and more accurate diagnostic methods, and the use of current epidemiological knowledge regarding the disease to facilitate the establishment of early treatment. .

Neurotuberculosis mimicking brain tumour; A case report.

Summary: Neurotuberculosis is one of the grave complications of primary tuberculous infection. Extensive BCG vaccination of children and inadequate antituberculous drug therapy have led to the emergence of newer complex clinical pictures and diagnostic dilemma. Here we report a case of right-sided hemiparesis with features of raised intracranial tension in a sixyear- old boy. Neuroimaging revealed presence of a high grade astrocytoma. On clinical examination, right-sided cervical lymphadenopathy with discharging sinus and tenderness over right hip joint were present. On further investigation, these were proved to be of tubercular origin. All preliminary findings were in favour of disseminated tuberculosis, but the nature of CNS lesion was creating diagnostic dilemma. Etiological diagnosis of the CNS lesion was necessary, as, if it was not of tubercular origin, the management protocol would be different and with any delay we could have lost the patient. Though on routine CSF study, no AFB were present, but we confirmed the presence of mycobacterial DNA by polymerase chain reaction. Patient showed considerable improvement after being put on Anti-tubercular Treatment (ATT) and steroids. Tuberculous brain abscess is rare. Very few cases have been reported even in adults. Most reported cases are in immunocompromised patients. This case highlights the fact that tuberculous brain abscess can have atypical presentation even in immunocompetent children mimicking CNS malignancy. Careful examination and thorough investigation are required to establish the diagnosis. Timely initiation of appropriate therapy can reduce mortality and neurological sequelae.

Tuberculous meningitis: do modern diagnostic tools offer better prognosis prediction.

Background: The British Medical Research Council (BMRC) staging has been extensively used to evaluate the disease severity and establish the approximate prognosis of tuberculous meningitis. Aims: This study aimed at analyzing the predictive accuracy for mortality and neurological sequelae of a set of clinical features, laboratory tests and imaging. Methods: We compared the British Medical Research Council (BMRC) staging with a new scoring proposal to predict the prognosis of patients with Central Nervous System Tuberculosis. Data from Ecuador was collected. A score was built using a Spiegelhalter and Knill-Jones method and compared with BMRC staging with a ROC curve. Results: A total of 213/310 patients (68.7%) were in BMRC stage II or III. Fifty-seven patients died (18.3%) and 101 (32.5%) survived with sequelae. The associated predictors were consciousness impairment (p= 0.010), motor deficit (p = 0.003), cisternal effacement (p=0.006) and infarcts (p=0.015). The new score based on these predictors yielded a larger area under the curve of 0.76 (95% CI: 0.70-0.82), but not significantly different from the BMRC (0.72: 95% CI: 0.65-0.77). Conclusions: This modern score is easy to apply and could be a sound predictor of poor prognosis. However, the availability of modern tests did not improve the ability to predict a bad outcome.

Tuberculous meningitis: do modern diagnostic tools offer better prognosis prediction.

Background: The British Medical Research Council (BMRC) staging has been extensively used to evaluate the disease severity and establish the approximate prognosis of tuberculous meningitis. Aims: This study aimed at analyzing the predictive accuracy for mortality and neurological sequelae of a set of clinical features, laboratory tests and imaging. Methods: We compared the British Medical Research Council (BMRC) staging with a new scoring proposal to predict the prognosis of patients with Central Nervous System Tuberculosis. Data from Ecuador was collected. A score was built using a Spiegelhalter and Knill-Jones method and compared with BMRC staging with a ROC curve. Results: A total of 213/310 patients (68.7%) were in BMRC stage II or III. Fifty-seven patients died (18.3%) and 101 (32.5%) survived with sequelae. The associated predictors were consciousness impairment (p= 0.010), motor deficit (p = 0.003), cisternal effacement (p=0.006) and infarcts (p=0.015). The new score based on these predictors yielded a larger area under the curve of 0.76 (95% CI: 0.70-0.82), but not significantly different from the BMRC (0.72: 95% CI: 0.65-0.77). Conclusions: This modern score is easy to apply and could be a sound predictor of poor prognosis. However, the availability of modern tests did not improve the ability to predict a bad outcome.

Meningitis tuberculosa en adultos: análisis de 53 casos / Tuberculous meningitis in adults: review of 53 cases

La meningitis tuberculosa (MTBC) es la forma más grave de tuberculosis extrapulmonar. El amplio espectro del cuadro clínico y su poca especificidad dificultan su diagnóstico precoz, relacionándose directamente con mayor letalidad. El objetivo de este estudio es analizar las características clínicas de los pacientes con diagnóstico de MTBC en el Hospital de Enfermedades Infecciosas Dr. Lucio Córdova, de Santiago, Chile, entre 1995 y 2002. Se estudiaron 53 casos de MTBC en adultos, con una edad mediana de 39 años. Al ingreso 66 por ciento de los pacientes presentaba algún grado de compromiso de conciencia, pero sólo 30 por ciento la tríada sintomática clásica. El LCR mostró aumento de proteínas, glucosa baja y linfocitosis, en la mayoría de los casos. Treinta por ciento de los pacientes presentó co-infección con VIH; la letalidad en este grupo de pacientes fue mayor, 31 vs 17 por ciento del total de la muestra. La MTBC continúa siendo una enfermedad vigente. El diagnóstico de certeza precoz de esta patología no es posible con los métodos actuales, por lo que la sospecha clínica es importante.

Meningitis tuberculosa en menores de cinco años en la Argentina / Tuberculous meningitis in children under 5 years of age in Argentina

La tuberculosis menígea en menores de cinco años continúia siendo un serio problema de salud pública en Argentina, con una tasa de 0.39/100 000 en el bienio 2003-2004. Esta tasa refleja las infecciones recientes y es un indicador operac ional de la búsqueda y tratamiento de casos adultos pulmonares y de la cobertura de la vacunación con BCG en el recién nacido. Este estudio se realizó con el objecto de describir las variables epidemiológicas y clínicas de los casos de meningitis tuberculosa en menorees de cinco años en Argentina en el período 1999-2001 y para obtener mayor certeza sobre el número real de menigitis que se producen en el país. Se estudiaron con fichas epidemiológicas 15 casos de meningitis de los 32 notificados (46.8%). La mediana de la edad fue 14 meses, 6 niños tenían cicatriz de BCG, pero en sólo uno se pudo constatar que fue vacunado al nacer, 11/13 (92.3%) estaban en estadio 2 de la enfermedad, la investigación bacteriológica resultó positiva en 8/11 (72.7%), por lo menos 7(46.8%) presentaron imágenes compatibles con tuberculosis pulmonar, la prueba tuberculínica resultó no reactiva en todos los casos en que fue aplicada. Este estúdio puso en evidencia que los niños se diagnosticaron en estadios avanzados de la enfermedad, ninguno curó sin secuelas y tubo un muy alto porcentaje de letalidad (46%). Para contrarrestar esta situación epidemiológica es necessario incrementar la búsqueda y tratamiento supervisado de casos bacilíferos, el estudio de contactos y la cobertura de vacunación con BCG al nacimiento.

Tuberculous (TB) meningitis in children under 5 years of age is a serious health problem in Argentina, with a rate of 0.39/100 000 inhabitants, for 2003-2004. This rate indicates recent infections. It is an operational indicator for case finding and treatment of pulmonary adult cases, and for BCG vaccination of the newborn. The object of this study was to describe epidemic an clinical varialbles registered in cases of TB meningitis in children less than 5 years old in Argentina, from 1999 to 2001 and to determine the real number of TB meningitis in children less than 5 years old in Argentina, from 1999 to 2001 and to determine the real number of TB meningitis cases in our country. Fifteen cases of TB meningitis out of 32 (46.8%) were studied through epidemic records. The average age woas 14 months. Sis children presented BCG scars but in only one child it was proved that he had been vaccinated at birth; 11/13 (92.3%) were at the second stage of illness, the bacteriological investigation was positive in 8/11 (72.7%) and in (46.8%) chest radiography revealed abnormal findings. The tuberculin reaction was negative in all tested cases. This study showed that the diagnosis was made at an advanced stage of disease. None of these patients was cured without sequels and a hight death rate (46%) was observed. In order to control this epidemic situation, it is necessary to increase case finding and directly observed treatment of smear positive pulmonary TB cases, as well as BCG vaccination given at birth.

Protective role of BCG vaccination against tuberculous meningitis in Indian children: a reappraisal.

BACKGROUND: The protective role of BCG vaccination against tuberculous meningitis (TBM) is still controversial in India, largely due to the presence of other predisposing factors such as age, nutritional and socioeconomic status, and household contact. Very few Indian studies have focused on the interaction between BCG and these factors on the occurrence of TBM. METHODS: We did an unmatched hospital-based case-control study with prospective enrolment. Children with TBM diagnosed on the basis of predefined criteria were enrolled as cases. For each case, two children admitted on the same day and who did not have any neurological symptoms were enrolled as controls. Demographic data and information on predisposing factors for tuberculosis were collected for both cases and controls and the presence of a BCG scar was charted. Cases and controls were compared by univariate followed by multivariate analysis to obtain significant independent predictors for the occurrence of TBM. To assess the interaction between other predisposing factors and protective efficacy of BCG, a stratified analysis was also done. RESULTS: A total of 91 cases and 182 controls were enrolled over a one-year study period, of which 37 cases and 111 controls had a BCG scar. The crude odds ratio for the occurrence of TBM in the absence of a BCG scar was 2.28 (range: 1.32-3.94). The time elapsed since vaccination was significantly longer in the cases. Also, the proportion with a household contact was significantly higher in the cases, the mean age of the cases was higher than that of the controls, and the mean weight and height for age percentage were significantly lower. The cases had a significantly lower socioeconomic status. On multivariate analysis, the significant independent predictors for the occurrence of TBM were positive household contact with tuberculosis (adjusted OR 4.26; 95% CCI 2.26-8.04), absent BCG scar (adjusted OR 1.98; 95%ClI 1.09-3.57) and rural residence (adjusted OR 2.07; 95% ClI 1.02-4.17). CONCLUSION: Vaccination with BCG was found to be protective even after controlling for the effect of other variables. Stratified analysis showed that protection due to BCG failed to reach significance for those > 5 years of age, if the weight was <6 0% of that expected for age, in the presence of a household contact with tuberculosis, and in socioeconomic classes III, IV and V.

Meningite tuberculosa: relato de 29 casos em população pediátrica no Brasil / Tuberculous Meningitis: report of 29 cases in Brazilian pediatric population

A prevalência de meningite tuberculosa (MTB) nos países em desenvolvimento mantém-se alta, e a doença continua a ter uma elevada taxa de morbimortalidade entre crianças. Neste trabalho, relatamos nossa experiência com casos de MTB, mostrando os achados clínicos, laboratoriais e radiológicos, assim como o tratamento e a seqüência após alta hospitalar. Foram revisados os registros de 29 pacientes com MTB ocorridos no período de 1o de janeiro de 1984 a dezembro de 2001. Houve predomínio do sexo masculino e da cor branca. A média de idade do início dos sintomas foi de 43 meses, variando de 2 meses a 12 anos. O esquema terapêutico mais freqüente foi rifampicina, isoniazida e pirazinamida. Seis pacientes evoluíram para óbito. Todos os pacientes realizaram exames culturais de líquido cefalorraquidiano para M tuberculosis, sendo positivos em 5 (17%). TB pulmonar foi detectada em 8 casos. O tempo médio de internação foi de 41 dias. Quinze de 21 pacientes pesquisados fizeram vacina BCG. Dezenove pacientes (66%) tinham história de contato íntimo com familiar com TB. Lesão cerebral motora foi a seqüela mais freqüente. Glicorraquia menor de 40 mg/dl foi relacionado como fator de risco para lesão cerebral motora, assim como idade menor de 4 anos de idade. Nossos achados mostram que a ocorrência de sinais meníngeos pode funcionar como um fator de proteção para a ocorrência de lesão cerebral motora assim como de proteinorraquia maior que 300 mg/dl (AU)

The prevalence of tuberculous meningitis (TBM) in the developing countries remains high, and this disease still has a elevated rate of morbimortality among children. In this study,we report our cases of TBM, describing clinical, laboratorial and radiological findings, as well the treatment and outpatient follow up. Medical charts from 29 patients interned with TBM from January 1984 to December 2001 were reviewed. There were predominance of male sex and white race. The mean age at the start of clinical manifestations was 43 months old, ranging from 2 months old to 12 years old. The more frequent tuberculostatic association was rifampin, isoniazid and pyrazinamide. Six patients died. Cerebrospinal fluid was collected from all patients, and the cultures for M tuberculosis were positive in five cases (17%). Pulmonary disease was detected in 8 cases. The mean time of hospitalization was 41 days. Fifteen from 21 patients has done BCG vaccine. Nineteen patients (66%) had contact with contaminated household. Motor cerebral lesion was the more frequent sequelae. Glucorrachia less than 40 mg/dl was related as a risk factor to motor cerebral lesion, as weel as age less than 4 years old. Our findings also point to the occurrence of meningeal signs and protein from cerebrospinal fluid above 300 mg/dl as protective factors for arising of motor cerebral lesion (AU)

Effectiveness of BCG vaccination against tuberculous meningitis.

OBJECTIVE: To assess the protective effectiveness of BCG vaccination against tuberculous meningitis, while controlling for age, nutrition and socio-economic status, in children 1 month to 12 years of age. DESIGN: Case-control study. SETTING: Secondary care referral and teaching hospital. METHODS: Cases were those conforming to the definition of tuberculous meningitis and controls were patients admitted after every third consecutive case included in the study from September 1995 till the end of August 1997 and who did not suffer from any central nervous system disorder. RESULTS: Among the 192 cases and 70 controls, BCG scar was present in 57.8% and 75.7%, respectively. The crude odd's ratio (OR)for tuberculosis meningitis with a BCG scar was 0.44 (95% CI, .24-0.81; p = 0.008), while the adjusted OR was 0.53 (95% CI, 0.26-1.06; p value = 0.07) after controlling for weight, age, sex and place of residence. Higher weight for age and urban residence were associated with a decreased risk of tuberculous meningitis in the logistic model. CONCLUSIONS: BCG vaccination offers protection against tuberculous meningitis. Since improvement in weight for age was associated with a decreased risk of disease, further studies are needed to evaluate the association, if any, between nutritional status and vaccine efficacy.

Meningoencefalite tuberculosa: avaliação de 231 casos / Tubercular meningoencephalitis: evaluation of 231 cases

This study assessed 231 cases of tuberculous meningitis of which 62 (26.8%) had diagnostic confirmation against 169 (73.2%) with only clinical picture and laboratorial indication for this diagnosis. Fifty-five percent of the sample was male; ages ranged from one month to 68 years, 42% comprising children below four years. Clinical, demographic and liquoric characteristics were investigated and compared amongst those with likely and confirmed diagnosis. In conclusion, attention is drawn to the severity of this disease with high rates of lethality mainly within the age-range of 0-4 years, and to the possibility of misdiagnosis in the presentation of acute forms and predominance of neutrophils in the liquor.

Neste estudo foram avaliados 231 pacientes com meningoencefalite tuberculosa, sendo que 62 casos tiveram diagnóstico comprovado e 169 apresentavam quadro clínico e laboratorial compatíveis com este diagnóstico. Foram 127 (55%) pacientes do sexo masculino, a idade variou de 1 mês a 68 anos, com 97 (42%) na faixa etária igual ou inferior a um ano. As características clínicas, demográficas e liquóricas foram estudadas e comparadas entre os casos confirmados e os de diagnóstico provável. Em conclusão reafirmamos a gravidade desta doença, com altas taxas de letalidade principalmente na faixa etária de zero a quatro anos e a possibilidade de erros diagnósticos nas apresentações com formas agudas e predominância de neutrófilos no líquor.

Tuberculous disease in a pediatric referral centre: 16 years experience.

Children with evidence of tuberculous disease registered at the TB Clinic, Institute of Child Health, Madras during the years 1977 to 1992 were analyzed. Progressive primary complex, is the commonest thoracic form of tuberculosis while tuberculous meningitis is the commonest extra thoracic form. The overall prevalence of various clinical forms of tuberculosis has decreased over the last 16 years. There is an increasing trend in the prevalence of progressive primary complex among the BCG vaccinated group. The prevalence of pleural effusion, bone tuberculosis and abdominal tuberculosis is almost same over the last 16 years and is more in the BCG non vaccinated children. In tuberculous adenitis there is no significant variation between the two groups. The occurrence of tuberculous meningitis is in the ratio of 1:3 among BCG vaccinated and non-BCG vaccinated children. Though the prevalence of miliary tuberculosis is negligible, it is significantly more in BCG non-vaccinated children. There is a tendency for slight decrease in overall mortality due to tuberculosis in the last 10 years but the mortality due to tuberculous meningitis continues to be the same over the past 16 years.

Tuberculosis meningoencefalica en el Hospital Nacional arzobispo Loayza: estudio retrospectivo 1985-1989 / Meningoencephalic tuberculosis in the Loayza Hospital: a retrospective study 1985-1989

Se revisaron 37 casos de tuberculosis menin-goencefálica en sdultos vistos entre 1985 y 1989 en el Hospital Nacional Arzobispo Loayza. Se examinaron las historias clínicas, resultados de laboratorio y los esquemas antituberculosos empleados. La mayoría de nuestros pacientes (73 por ciento) fueron adultos jóvenes, con una enfermedad fundamentalmente de inicio insidioso (86.48 por ciento) y curso subagudo (56.75 por ciento) o crónico (32.43 por ciento). Cefalea fue el síntoma de inicio (64.86 por ciento) y neurológico (91.81 por ciento) más frecuente. 35 pacientes (95 por ciento) presentaron signos meníngeos, 13 pacientes (35 por ciento) compromiso de pares craneales, 13 pacientes (35 por ciento) signos de focalización y 2 (5 por ciento) paraplejía con nivel sensitivo. Los hallazgos citológico y bioquímico de líquido cefalorraquídeo (LCR) fueron muy variables pero útiles en la presunción diagnóstica. Enfatozamos la necesidad de un diagnóstico temprano basado en datos clínicos, epidemiológicos, de LCR y placa de tórax que permita el inicio temprano del tratamiento específico.

Comportamento da meningite tuberculosa nos Estados do Nordeste - período 1982/1992 / Menigitis Tuuberculosis in Northeasteru Brazil between 1982-1992

Medidas profiláticas e terapéuticas eficientes promoveram o declínio da prevalência da meningite tuberculosa nos países desenvolvidos, fato que infelizmente näo ocorreu naqueles ditos em desenvolvimento. A meningite tuberculosa representa a forma mais comum da neurotuberculose e apresenta a maior taxa de mortalidade entre as formas extra-pulmonares. A cura está relacionada com a precocidade do tratamento. A cronificaçäo da doença é observada quando se instalam lesöes cerebrais irreversíveis ou profundas alteraçöes do sistema de circulaçäo do líquido cefalorraquidiano, as quais promovem o aparecimento de sequelas graves e evoluçäo fatal. Este trabalho investigou os dados fornecidos pelo Ministério da Saúde, quanto a prevalência da meningite tuberculosa no Nordeste, no período de 1982-1992, bem como a efetividade da vacinaçäo BCG(pelo Bacilo de Calnett e Guérin) intradérmica. Pelas informaçöes ainda bastante incompletas pode-se concluir que apesar dos progressos alcançados nas últimas décadas a meningite tuberculosa ainda constitui grave problema de Saúde Pública, bem como confirmar que o BCG intradérmica usada no pais é apropriada para evitar apenas as formas mais graves. Sendo assim, é necessário que sejam empregados esforços com a finalidade de aumentar a cobertura vacinal, diagnóstico e tratamento precoces, para que seja possível um controle mais efetivo dessa endemia

Case series evaluation of BCG vaccine efficacy against tubercular meningitis in children in Delhi.

Tubercular meningitis (TBM) is a very serious disease of childhood. BCG vaccination under Universal Immunisation Programme is the only available way of preventing this disease. The present series using case-control method, evaluated efficacy of BCG against TBM in children to be 57 per cent. Suggestion has been made to initiate TBM surveillance in children and conduct multicentric prospective case-control study of similar type.

Meningoencefalitis tuberculosa en niños: diez años de experiencia en el Hospital Nacional Cayetano Heredia / Tuberculous meningoencephalitis in children: 10 year of experience at Hospital Nacional Cayetano Heredia

Se investigó las características epidemiológicas, clínicas y de laboratorio de una serie de setenta pacientes diagnosticados de meningoencefalitis tuberculosa infantil entre 1982 y 1991, en el Hospital Nacional Cayetano Heredia de Lima. El promedio de casos por año fue 7, menor que lo reportado previamente, y los escolares fueron el grupo más afectado. El contacto tuberculoso y el hacinamiento fueron los antecedentes epidemiológicos predominantes. La población de lactantes se caracterizó por tener menor número de vacunados con BCG, mayor número de síntomas respiratorios en sus antecedentes y mayor frecuencia de radiografía de torax patológica. El factor más importante para el estudio clínico y la condición de alta fue el tiempo de compromiso de conciencia previo a la hospitalización. Las características clínicas y de laboratorio fueron muy similares a lo previamente reportado y la letalidad encontrada fue 14.3 por ciento.

Meningoencefalitis tuberculosa en el Hospital Dos de Mayo de Lima / Tuberculous meningo-encephalitis in Hospital Dos de Mayo of Lima 1985 - 1989

Se realizó un estudio retrospectivo-prospectivo para conocer las características clínicas y la morbimortalidad de la meningoencefalitis tuberculosa (MEC TBC) del adulto. De 124 historias clínicas con ese diagnóstico en el Hospital Dos de mayo de Lima entre 1985 - 1989, 97 cumplieron los criterios de inclusión. Se halló que la población más afectada fue de jóvenes, solteros, migrantes, de bajas escolaridades y renumeraciones. La forma de presentación más frecuente fue de inicio insidioso (91.1 por ciento) y curso subagudo (59.4 por ciento); con contactos TBC, (29.1 por ciento); con antecedentes de TBC, (42.5 por ciento); hipoglucorraquia (53.6 por ciento), hiperproteinorraquia (95.2 por ciento), pleocitosis (98.9 por ciento); BK directo, 0 por ciento; con TBC pulmonar, 70.5 por ciento; PPD positivo, 36.0 por ciento ; estadío moderado de enfermedad, 67.0 por ciento; tratamiento adecuado, 94.8 por ciento ; corticoterapia, 79.4 por ciento; hospitalización mayor de 30 días, 42.2 por ciento; fallecidos, 30.,9 por ciento; seguimiento ambulatorio, 59.7 por ciento; recaídas, 11.9 por ciento. Después del alta fueron ubicados 41 pacientes (61.2 por ciento), de los cuales 22 (53.7 por ciento), 9 (21.9 por ciento), y 2 (4.8 por ciento) con categorías 1, 2 y 3 respectivamente, más 8 (19.5 por ciento) fallecidos. Se concluye que la MEC TBC afecta a la población joven, de bajo nivel socioeconómico, que la mortalidad es alta, que la morbimortalidad al alta correlaciono con la edad y la condición clínica al ingreso, no correlacionó con otros factores. La morbimortalidad al seguimiento correlacionó con la edad y el tratamiento ambulatorio irregular

Epidemiological evaluation of BCG vaccine efficacy in Delhi--1989.

A field evaluation of efficacy of BCG vaccine to prevent tubercular meningitis was undertaken in a case control study in Delhi during 1988-89. Each case of tubercular meningitis was matched by age and neighbourhood with 2 controls from the community. Thirty-seven cases of tubercular meningitis were matched with 74 controls and thus 37 triplets were analysed. ODDS RATIO between BCG vaccinated and non vaccinated individuals for acquisition of tubercular meningitis was 11.3. This gives 84 per cent efficacy of BCG vaccine in the prevention of TB meningitis under the field conditions prevailing in Delhi. Paired matched analysis of tubercular meningitis with the control group 1 and 2 separately revealed the ODDS RATIO to be 9.5 and 15 respectively. The corresponding BCG vaccine efficacy worked out were 90 and 93 per cent respectively. Authors suggest that this method of evaluating BCG vaccine efficacy is fairly reliable and cost effective. This methodology could be further simplified by using hospital patients as control and be introduced to evaluate BCG vaccine efficacy in different areas with reference to its role in preventing tubercular meningitis under the programme of immunisation.