IP International Journal of Medical Paediatrics and Oncology


Comparison of Tuberculous meningitis in children with or without BCG Scar


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Author Details: Ravindra Kumar, Binod Kumar Singh, Tauhid Iqbali

Volume : 2

Issue : 4

Online ISSN : 2581-4702

Print ISSN : 2581-4699

Article First Page : 142

Article End Page : 145


Abstract

Background: Most serious form of tuberculosis in children is tubercular meningitis. TBM remains a significant cause of hospitalization, death, and permanent neurological disability in children in India. Even though the BCG vaccine has been used from past 80 years, there remains a shadow of doubt about its value in protection against tuberculosis children. Adapted clinical presentation of tuberculous meningitis (TBM) in children vaccinated with BCG has been defined in the literature. It is significant to recognize the full clinical spectrum of TBM in BCG vaccinated children so that the diagnosis is not overdue. With more children being vaccinated nowadays, the clinical spectrum of TBM changing. We, therefore, started this prospective study to compare the clinical, biochemical and radiological skins of TBM in BCG vaccinated and unvaccinated progenies.
Methods: It was a prospective cross- sectional study conducted with a total of 100 successive hospitalized children with tubercular meningitis.(76 vaccinated, 24 unvaccinated).They all satisfied predefined criteria for the diagnosis of TBM. Clinical, bio-chemical and radiological features of children with/without a BCG scar were compared.
Results: Univariate analyses showed that the vaccinated children with TBM had significantly lower rates of altered sensorium and focal neurological deficits and higher mean Glasgow Coma Scale score and cerebrospinal fluid cell count. Signs of raised intracranial tension were more common in the unvaccinated group. Hydrocephalus and tuberculoma were more common in unvaccinated children. Short-term outcome was significantly better in the vaccinated group. Mortality was more in the unvaccinated group.
Conclusion: Children of TBM who have been vaccinated with BCG appear to maintain better mentation and have a superior result. This may be explained by the better immune response to infection, as mirrored in the higher CSF cell counts in this group in the present study.

Keywords:
TBM, BCG