Diagnosis of central nervous system tuberculosis in pediatric patients.

Abstract

Introduction. Central nervous system tuberculosis (CNS TB) represents a severe form of Mycobacterium tuberculosis (Mtb) infection. Late diagnosis is associated with increased mortality and neurological sequelae. Objective. To characterize CNS TB diagnosed in a pediatric hospital and describe the diagnostic elements, estimating their sensitivity. Materials and methods. An observational, retrospective study included CNS TB cases diagnosed between January 2013 and February 2022. Medical and laboratory records were reviewed, and epidemiological, clinical, imaging, cerebrospinal fluid cytochemical, and bacteriological data for mycobacteria were recorded. Results. Twenty-six cases of CNS TB were diagnosed, and 22 had pulmonary involvement. Ninety-six percent had neurological symptoms, with sensitivities of 46% for focal symptoms, 92% for meningeal symptoms, and 73% for the presence of fever. Hydrocephalus was more frequently observed in children under 5 years of age. In the study of cerebrospinal fluid, the clear aspect (92%) and proteins upon 1 g/L (50%) showed higher sensitivity, with higher levels in children under 5 years of age. As for microbiological results, smear microscopy was negative in all cases, while molecular biology and culture showed 61% and 75% sensitivity, respectively. The detection time was significantly shorter for molecular biology than for culture (p < 0.01). Conclusions. The presence of neurological symptoms, compatible cerebrospinal fluid, epidemiological link, and pulmonary involvement showed high sensitivity. Molecular biology allowed for earlier microbiological confirmation.