Clinical Pediatrics

Background: As early diagnosis of childhood tuberculous meningitis (TBM) cannot rely on mycobacterial confirmation, clinical, CSF and neuroimaging features are essential. We aimed to describe the evolution of serially-analyzed lumbar CSF parameters.

 

Methods: We performed a retrospective observational study including children <13 years with suspected TBM, prospectively enrolled in several research studies at Tygerberg Hospital, Cape Town, South Africa, over a 30-year period. Demographic and clinical data were analyzed, as well as CSF parameters at admission, week 1, 2 and 3.

 

Results: Of 318 children with suspected TBM, 53 (17%) had definite TBM and 265 (83%) probable TBM. Serial CSF analysis from admission to 3 weeks post-admission showed decrease in mean lymphocyte count (143 to 49/μL), neutrophil count (53 to 9/μL), protein concentration (3.29 to 1.85 g/L), and rise in mean glucose concentration (1.89 to 2.72 mmol/L). Longitudinal clustering revealed three distinct profiles, with 1 group atypically demonstrating initial increase in lymphocyte count, neutrophil count and protein concentration. The decreasing CSF glucose trend remained uniform amongst all groups. Conclusion: Serial lumbar CSF in TBM suspects may demonstrate different trends over time. A gradual decline in CSF lymphocyte, neutrophil and protein count, and rise in CSF glucose concentration is expected, however normal variability exists.