Last modified: 2018-09-09
Abstract
Introduction: Neurotuberculosis, described as a disease of the lower socio-economic strata in developing countries, constitutes 5% of all extrapulmonary tuberculosis cases. We aim to highlight the changing face of neurotuberculosis in urban India with respect to presentations, diagnostic methods and treatment choices.
Methodology: We retrospectively analyzed 36 patients of neurotuberculosis presenting to our Pediatric Neurology Clinic. We studied their predisposing factors, clinical, laboratory features and response to treatment.
Results: 28/36 patients presented with classical tubercular meningitis while 8 presented atypically. Of the atypical cases 7/8 were adolescent girls, 7/8 belonged to a high socio-economic background. 2/8 presented with atypical features – one with isolated abducent palsy with focal enhanced meningeal thickening diagnosed on biopsy & one with persistent headache with CSF showing AFB. Both responded to category 1 treatment.
6/8 patients had multi-drug resistant tuberculosis(MDR-TB), of which 2 were immunocompromised but the rest were healthy, school-going children with a fulminant course. Only 1/8 was Gene Xpert positive. All showed thick, rope like basilar & spinal exudates on neuroimaging. 2/8 needed treated with thalidomide & streptolysin. All 6/8 had persistent fever on routine AKT, relapsed on tapering steroids, requiring prolonged treatment with dexamethasone & category 2&3 drugs. Koch’s contact varied from house help, school friend to parent.
Conclusion:
In developing countries TB remains a serious diagnosis to consider irrespective of the clinical presentation, age or socioeconomic strata.
Adolescent healthy girls, from educated, high-income families, fulminant MRI changes, persistent fever on AKT, relapse on tapering steroids were common factors in our MDR-TB patients.