TUBERCULOSIS MENINGITIS IN CHILDREN: MODERN REQUIREMENTS TO DIAGNOSTICS

Тhe aim: to analyze reasons of late diagnostics and course specifics of tuberculosis meningitis (TBM) in children in Saint Petersburg, Russia.

Materials and methods: Data was obtained from the Russian official statistics on the frequency of childhood tuberculosis meningitis in 2000-2016. We also analyzed the frequency, the course and the diagnostic specifics of tuberculosis meningitis in children in 2005–2016 in Saint Petersburg.

Results and discussion: In the Russian Federation the number of children diagnosed with tuberculosis meningitis per year was reduced from 51 in 2000 to 13 in 2016. In Saint Petersburg over the period of 2005 to 2016 there were seven registered cases of childhood tuberculosis meningitis. Unfortunately only three children out of seven in Saint Petersburg tuberculosis meningitis cases survived. The main factors associated with tuberculosis meningitis in children were young age, children three years old and younger (5 out of 7 children), the presence of a TB patient in the family (6 out of 7 children), lack of BCG vaccination (5 out of 7 children), and poor socio-economic situation (5 out of 7 children). Three out of seven children developed tuberculosis meningitis after becoming HIV positive. The following methods of tuberculosis meningitis diagnostics exist in Russia: Diaskintest, PCR, and Bactec culture tests for Mycobacterium tuberculosis. QuantiFERON-TB Gold and T-SPOT.TB are available but too expensive for most patients. However, a low prevalence of tuberculosis meningitis cases resulted in insufficient attention to TBM, late diagnostics and fatal cases. Three clinical cases were analyzed.

Conclusion: To improve tuberculosis meningitis treatment outcomes it is necessary to raise awareness of TB infection among treatment providers, especially when evaluating high risk children population. It is critical to determine presence of latent Mycobacterium tuberculosis, use all etiological diagnostic methods, including PCR and Bactec, when analyzing cerebrospinal fluid and other specimen, and initiate anti-TB treatment immediately when tuberculosis meningitis is suspected. 

1. Tuberculosis in the Russian Federation, 2012/2013/2014. – Moscow (Russia), 2015. – 312 p.

2. Yanchenko EN., Greymer MS. Tuberculosis at children and teenagers: The management for doctors. Saint-Petersburg (Russia): Hippocrates; 1999, 336 p.

3. Kobeleva YaM, Greenberg LM, Chugayev YuP, et al. Lethal cases of tuberculosis in children: kliniko-epidemiological data. Ural’skij medicinskij zhurnal. 2011; 1: 72-76.

4. Chugayev YuP, Greenberg LM. The klinikal and morfological characteristic of lethal cases in infants with primary tuberculosis. Sverdlovsk (Russia): Materialy Sverdlovskogo filiala NPO «Ftiziopul’monologija»; 1991; 96-100.

5. Kamayeva NG, Chugayev YuP. The experience of revealing and diagnostics of tubercular meningitis in children. Medicinskij al’jans. 2014; 2: 32-38.

6. Bang ND, Caws M, Bang ND, et al. Clinical presentation, diagnosis, mortality and prognostic markers of tuberculosis meningitis in Vietnamese children: a prospective descriptive study. BMC Infect Dis. 2016; Oct 18; 16 (1):573

7. Dhawan SR, Gupta A, Singhi N, et al. Predictors of Neurological Outcome of Tuberculous Meningitis in Childhood: A Prospective Cohort Study From a Developing Country. J.Child Neurol. 2016 Dec;31(14):1622-1627.

8. Sevostyanova TA, Klimov GV, Shirshov IV, et al. Tubercular meningitis in infants. Tuberkulez i social’no znachimye zabolevanija. 2014; 5: 32-39.

9. Shilova MV, Tuberculosis in Russia in 2014: Monograph. Moscow (Russia): Pero; 2015.240 p.

10. Skripchenko NV, Ivanova MV, Vilnits AA, Skripchenko EYu Neuroinfections at children tendencies

11. and prospects. Rossijskij vestnik perinatologii i pediatrii.2016; 4: 9-22.

12. Sorokina MN, Ivanova VV,. Bacterial meningitis in children. Moscow (Russia): Medicine; 2003. 320 р.

13. Skripchenko NV et al, Cerebrospinal fluid and prospects of its studying Rossijskij vestnik perinatologii i pediatrii.2011; 6: 88-97.

14. Vilnits AA, Ivanova MV, Skripchenko NV., et al. Klinikoepidemiological aspects of a generalized meningococcal infection in children and teenagers of St. Petersburg. Pediatr. 2017; 8, 84.

15. Klochkova LV, Lozovskaya ME. Actual issues of modern diagnosis of tubercular meningitis in children at the present stage. Materials of V Baltic congress on children’s neurology. Saint-Petersburg; 2015. р.192-193.

16. Korol OI, Lozovskaya ME. Tuberculosis in children and teenagers. Saint-Petersburg (Russia) Piter; 2005. 432 p.

17. Harchenko GA, Kimirilova OG, Chabanova ON. Tubercular meningitis in children and teenagers. Tuberkulez i bolezni legkih. 2017; 1:47-50.

18. Lozovskaya ME, Belushkov VV, Gurina OP, et al. Comparative evaluation of innovative diagnostic tests for latent and active TВ infection in children. Pediatr. 2014; 3:46-50.

19. Rumzan A, Navil K, Asimi R. et al. Childhood tubercular meningitis: an institutional experience and analysis of predictors of outcome. Pediatr Neurol. 2013 Jan;48(1):30-5.

20. Vita S, Caraffa CE, Mascia MC. et al. Immunological diagnosis as an adjunctive tool for an early diagnosis of tuberculous meningitis of an immune competent child in a low tuberculosis endemic country: a case report. ВМС Res Notes. 2017 Mar 13;10(1):123.

21. Federal clinical recommendations about diagnostics and treatment of a latent tuberculosis infection in children. Moscow (Russia) ROOI «Zdorov’e cheloveka»» 2015. 36 p.