It’s a complication of Childhood tuberculosis & common cause of prolonged morbidity, handicap & death.
Children below 5 years are specially prone.
Always sec. to primary tuberculosis.
First Phase : Vague symptoms.
Child doesn’t play, is irritable, restless or drowsy.
Anorexia & vomiting may be present
Older child may complain of headache.
Possibly preceding history of Measles or another illness with incompletely recovery
SECOND PHASE :
Child is drowsy with neck stiffness, & rigidity.
Kernig & Brudzinski sign may become positive, anterior fontanels bulges
Twitching of muscles, convulsions, raised temperature.
strabismus, nystagmus, and papilloedema may be present.
Fundoscopy: Choroidal TB may be seen
Child is characteristically comatose with opisthotonus, & multiple focal paresis.
Cranial nerve palsies are present.
High grade fever often occurs terminally.
Lumbar Puncture : pressure usually raised,
10-500 PMNs early but later lymphocytes predominate
Glucose less than 50mg/dl in most cases
Culture for tubercle bacilli.
Presence of tuberculous focus elsewhere in the body is strong supportive diagnosis.
Tuberculin skin test .
Antituberculous Therapy: Includes simultaneous administration of 4 drugs (Isoniazid, rifampicin,streptomycin , pyrazinamide) for first 3 months, followed by 2 drugs for another 15 months usually Rifampicin & INH.
Total period: 18 months.
STEROIDS: to reduce cerebral edema and to prevent subsequent fibrosis & subsequent obstruction to CSF
2mg/kg/24 hours of prednisolone for 6-8 weeks at the start of treatment starting 3 days after initiation of anti tuberculous therapy.
Partially treated bacterial meningitis
Chronic meningitis is a constellation of signs and symptoms of meningeal irritation associated with CSF pleocytosis that persists for longer than 4 weeks.
General physical- Check for Consciousness level according to GCS scoring, jaundice or irritability.
Resuscitation: incase of septic shock, or DIC.
Vitals: temperature , HR, B.P., R/R.
Signs of Increased ICP- Bulging fontanelle, headache, nausea, vomiting, ocular palsies, altered level of consciousness, and papilledema
CN palsies: (esp. occulomotor, facial, and auditory)
Meningismus - check for nuchal rigidity with passive neck flexion (gives 'involuntary resistance).
Brudzinski sign (hip & knee flexion with neck movement)
Kernig sign (extend knee with hip flexed)
Rash: petechial or purpuric rash (not only in meningococcal but also pneumococcal bacteremia).