Symptoms of TB meningitis in kids ‘needlessly’ diagnosed too late
TUBERCULOSIS (TB) meningitis is one of the most common infections in children and if the disease is not treated early enough in children in the Western Cape it will result in needless disabilities and death.
The Stellenbosch University study, conducted at Tygerberg Hospital on 139 children with meningitis, found 79 were diagnosed with TB meningitis, mostly viral meningitis as compared with bacterial meningitis.
The incidence of the disease in the province is among the highest in the world, with 50 children admitted to Tygerberg Children’s Hospital each year.
The research, which has been published in the International Journal of Tuberculosis and Lung Disease, showed only 15 percent of children admitted to the hospital with TB meningitis were in the early stage of the disease, or so-called stage 1.
The children, aged from 3 months to 13 years, who were enrolled as part of the study, had their meningitis confirmed using cerebrospinal fluid analysis.
Most were HIV-negative, and only 8 percent were HIV-positive.
Professor Regan Solomons, who conducted the study as part of his PhD research, found by the time these children were admitted to hospital, most already showed symptoms of advanced illness such as depressed levels of consciousness, stroke, coma or brain damage.
Most of them (85 percent) had stage 2 or 3 diseases – a prognosis that exposed them to more serious and permanent brain and neurological damage such as cerebral palsy, epilepsy, severe behavioural problems and blindness.
Solomons, a neurologist at Hospital, said while the early symptoms were non-specific and difficult to detect, implementation of the existing integrated management of childhood illness (Imci) guidelines “was extremely useful for the early detection and treatment initiation of TB meningitis”.
In a study performed at Tygerberg Hospital, 70 percent of children had potential TB features and recent household TB contact but, Solomons said, only one was correctly identi- fied as a likely TB patient.
He blamed clinics for their failure to detect TB and said they were not picking up on TB diagnosis early enough – resulting in many of these children getting severe forms of TB such as TB meningitis.
“Children with TB meningitis tend to have three or four contacts with health professionals before they come to me.
“There are many lost opportunities at the clinic.
“The thing that missed in clinics is when children vomit but there is no diarrhoea.
“Sometimes it is misdiagnosed as gastro, but you can’t have gastro with only vomiting with no diarrhoea,” he said.
Solomons said persistent vomiting could be a sign there was raised pressure in the brain. Sadly, parents were also not recognising the symptoms of TB meningitis – such as poor weight gain, persistent coughing of more than two weeks, non-specific symptoms longer than five days, and contact with a TB patient.
Solomons’s research also showed that chest X-rays did not necessarily detect pulmonary TB, and less than half of the TB meningitis patients in his study had a chest X-ray detecting TB.
The most effective scoring categories were cerebrospinal fluid findings, followed by clinical criteria and neuro-imaging findings.