Factors influencing the presentation and outcome of tuberculous meningitis in childhood.

UNLABELLED: Tuberculosis (TB) is an important cause of morbidity and mortality worldwide. Here, we describe our experience of childhood tuberculous meningitis (TBM), focusing on factors influencing presentation and outcome. PATIENTS AND METHODS: Children aged 0-14 years, with diagnosis of TBM and 24 months of post-therapy follow-up, were evaluated in this retrospective study. RESULTS: Thirty-two patients with TBM were identified. Fever, nuchal rigidity and vomiting were the main presenting symptoms. Fourteen cases (44%) presented with cranial nerve palsy. Seventeen (53%) patients were in advanced stage of the disease on admission. Cerebrospinal fluid (CSF) examinations showed low glucose, high proteins and pleocytosis. A central nervous system device was placed in 4 cases (13%) because of worsening hydrocephalus. Four (13%) patients died, while 6 (19%) had sequelae. Faster normalization of CSF parameters was associated with better outcome. CONCLUSION: Early antimycobacterial therapy and close monitoring of TBM in childhood improve the outcome.

Pulmonary aspergillosis with possible cerebral involvement in a previously healthy pregnant woman.

UNLABELLED: Invasive aspergillosis is observed mainly in immunodepressed patients. Here we report a case of pulmonary aspergillosis with CNS involvement in a pregnant woman without other known causes of immunodeficiency. CASE REPORT: A 23-years old pregnant woman underwent a caesarean because of unexplained seizures. During the subsequent days worsening headache and a deteriorating neurological status were reported suggesting meningitis. Stiffness, right sided hemiparesis and cranial nerve palsies were observed at admission. Radiological findings revealed lesions involving the right pulmonary apex, the right cerebellar hemisphere and the Pterygopalatina fossa. Microbiological studies revealed large colonies of Aspergillus fumigatus. A favorable outcome was observed after administration of liposomal amphotericin B and 5-fluorocytosine and, at improved conditions, when oral uptake of itraconazole was given. The authors conclude that risk of infections sustained by fungal opportunistic agents during pregnancy must be considered. Sequential antifungal administration may be an efficient therapy able to shorten hospitalization.

[Tuberculous meningitis in childhood: review of cases observed in the years 1995-1999]. / La meningite tubercolare in eta' pediatrica: considerazioni sui casi osservati negli anni 1995-1999.

UNLABELLED: In this study we reviewed M. tuberculosis meningitis (TBM) cases in childhood at our unit in a five-year period. METHODS: Included in this retrospective study were children admitted to Cotugno Hospital from 1995 to 1999 who fulfilled criteria for a TBM diagnosis. Medical records were analyzed for epidemiological data, clinical manifestations, laboratory test results, radiological investigations and clinical outcome. RESULTS: We identified 10 children with TBM. Family history of tuberculosis (TB) was observed in 6 patients. Fever preceded hospital admission of 4-60 days (median 8 days); neurological signs were present 1-6 days before admission in 8 patients. All patients showed a predominance of lymphocytes, elevated proteins and reduced glucose concentration in cerebrospinal fluid (CSF). Mycobacterium tuberculosis was either cultured or identified by acid fast stain in 5 patients. Cranial CT-scans and MRI showed hydrocephalus in 8 patients and ring-enhancing lesions in 6. Antituberculous therapy was administered according to current recommendations for at least 12 months, with a 4-6 week steroid therapy course. Two patients had permanent neurological sequelae. CONCLUSIONS: Careful evaluation of symptoms and CSF findings is the only way to establish an early diagnosis and reduce sequelae.