Central nervous system tuberculosis in children: review of 35 cases at the Hospital Universitario San Vicente de Paúl in Medellín, Colombia.1997-2004

Abstract

OBJETIVE. To document the clinical and diagnostic features and to explore factors associated with central nervous system tuberculosis at the “Hospital San Vicente de Paúl (HUSVP)” in Medellín- Colombia.

PATIENTS AND METHODS. Review of the patient’s records to obtain information on demographic data, medical history, clinical manifestations, laboratory results, treatment and complications of 35 children with central nervous system tuberculosis admitted to the hospital between July 1997 and July 2004.

RESULTS. Of the 35 patients, 20 were males and 15 females. Mean age was 3.7 years. Thirty (85.7%) patients were in stage III of the disease and 5 (14.3%) in stage II. A symptomatic respiratory close contact was documented in 19 cases (54.3%). Malnutrition was present in 18 patients (51.4%).

Fever was present in 88.6%, vomiting in 62.9%, consciousness alteration in 80%, and seizures in 51.4%. Mean duration of symptoms was 10 days. Physical examination revealed meningeal signs in 77%, movement disorders in 31.4%, stupor or coma in 82.9%, hemiparesis in 60% and fundoscopic abnormalities in 31.4%.

Tomography showed hydrocephalus in 88.7%, basal meningitis in 57.1%, gangliobasal infarction in 48.6% and tuberculomas in 11%. Mycobacterium tuberculosis was isolated in 11 patients (31%). The overall mortality rate was 17%.

CONCLUSION. A positive tuberculosis contact at home, more than 10 days of symptoms, hydrocephalus and abnormal movements in the physical examinations strongly suggest the diagnosis of central nervous system tuberculosis. The presence of papilloedema and CSF positive culture for M. tuberculosis were related with death.