| On Tuberculous Meningitis in Korean Children |
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Erling Skoglund |
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Pediatric Department, N.M.C. |
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| Abstract |
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This is a study of tuberculous meningitis in children in the Pediatric Department of National Medical
Center. From Nov. 58 to Sep. 61 there were 83 cases with the diagnosis tuberculous meningitis. However,
29 cases were excluded frorh the material, because they did not fill the diagnostic criteria. In the remaining 54 cases there were 31 boys and 23 girls up to 12 years of age. More than 50% were below 4 years
of age, which fits with what is generally reported. Only 12 cases(=22%) showed positive finding of AFB
in spinal fluid, probably due to that most cases had got some treatment before coming to NMC. The
most striking finding is the length of the previous history. A previous history of meningoencephalitis
symptoms for less than 2 weeks was found in only 10 cases(=18,5%). In 70% the history was 1 month
and more, in 60% it was 2 months or more, in 26% it was 6 months or more. 12 cases(=22%) had no
previous anti-tuberculous treatment, 17 cases(=31%) had irregular and interrupted treatment and 12 cases
(=22%)had continuous previous treatment, but the dosage was unknown. Treatment of unknown kind
had been given in 13 cases(=24%). After coming to NMC we have given usually streptomycin 40 mjg/kg
body weight, isoniazide 10-20 ifig/kg and para-atninosalicylic acid 200-300 mg kg. SM has usually been
discontinued after 4-6 weeks, but INH and PAS has continued for lohg time. The results are rather
disapointing. Only 15 cases(=28%) have returned to normal condition without any sequelae. 27 cases(=5
0%) have neurologic sequelae, mostly hemiparesis, arid 6 cases(=ll%) died. 3 cases had psychic sequelae
and 3 cases are unknown. If these results are correlated to the length of the previous history we find what we expect. the longer the previous history is, the worse are the results. The cases with a previous history shorter than 2 weeks have returned to normal in 60%, the cases with a previous history 2 week-2 months have return
ed to normal in only 25%. If the results are correlated to the previous treatments, we find the best results in those patients who got no previous treatment, but the difference is rather small. Anyhow the previous treatmentthe seems to havebeen of no value for the results, probably due to that it has been given irregularly or in too small doses. The most encouraging observation from our treatment is that even after very long time of treatment some further improvement seems to be possible, even if that is exceptional. This material is perhaps not representative for more than NMC, but it shows clearly, that too many patients with tuberculous meningitis get insufficient treatment. The importance of early, combined treatment with sufficient doses for very long time is stressed. It is of no value to start treatment if the patient cannot be guarantied continuous treatment
for long time.
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