Study on biochemical and radiological profile in children clinically diagnosed as tubercular meningoencephalitis: a prospective study from a tertiary care centre in Rajasthan

Authors

  • Suresh Goyal Department of Pediatrics, R. N. T. Medical College, Udaipur, Rajasthan, India
  • Shashi Bala Jonwal Department of Pediatrics, R. N. T. Medical College, Udaipur, Rajasthan, India
  • Anuradha Sanadhya Department of Pediatrics, R. N. T. Medical College, Udaipur, Rajasthan, India
  • Juhi Mehrotra Department of Pediatrics, R. N. T. Medical College, Udaipur, Rajasthan, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20204040

Keywords:

Cartridge based nuleic acid amplification test, Cerebrospinal fluid, Neuroimaging, Tubercular meningoencephalitis, X-ray chest

Abstract

Background: Objective of the current study was to assess biochemical profile and neuroimaging findings in children diagnosed with neurotuberculosis in a tertiary care centre in Southern Rajasthan, India.

Methods: A prospective randomized controlled trial was conducted in Department of Pediatrics, tertiary care centre in Southern Rajasthan, India from July 2017 to June 2018. Total 110 children of age group of 6 months to 18 years with the diagnosis of tubercular meningoencephalitis (TBME) on the basis of clinical evaluation, cerebrospinal fluid (CSF) examination and neuroimaging were included in the study.

Results: Among 110 children included in the study, CSF lymphocytic pleocytosis was seen in all. Majority of children (56.36%) cell counts were in the range of 101-500 cells/µl and mean CSF cell count was 198.09±177.86 per µl. CSF protein ranges from 100 to 400 mg/dl in 68.2% children and 19 children had CSF protein >400 mg/dl with mean of 230.98±167.73 mg/dl. In majority of patients (40%) CSF glucose level was in range of 20-40 mg/dl and in 31.82% children CSF glucose was <20 mg/dl. Mean CSF sugar level was 33.86±18.22 mg/dl. None of them demonstrated acid fast bacillus (AFB) on Ziehl-Neelsen staining of CSF sample. Chest radiographic abnormality was found in 41.82% cases. Mantoux test was positive in 16.36% (18) children admitted with TBME. Common abnormalities noted on neuroimaging were: Communicating hydrocephalus (77.27%), meningeal enhancement (40%), infarction (27.27%), cerebral oedema (11.82%) and 9.09% has tuberculoma on neuroimaging. CSF and gastric aspirate were examined by cartridge based nuleic acid amplification test (CBNAAT) for Mycobacterium Tuberculosis (MTB), among them 5 (4.55%) children had positive in CSF and 16 (14.55%) had gastric aspirate positive for MTB by CBNAAT.

Conclusions: Clinical, biochemical and radiological parameters is sufficient enough to diagnose TBME in children.

Author Biographies

Suresh Goyal, Department of Pediatrics, R. N. T. Medical College, Udaipur, Rajasthan, India

Resident,

Departmen of Pediatrics

Shashi Bala Jonwal, Department of Pediatrics, R. N. T. Medical College, Udaipur, Rajasthan, India

Sr. Professor and Ex-Head
Department of Pediatrics
RNT Medical College, Udaipur (Raj.)

Anuradha Sanadhya, Department of Pediatrics, R. N. T. Medical College, Udaipur, Rajasthan, India

Associate Professor

RNT Medical College

Udaipur (Raj.)

Juhi Mehrotra, Department of Pediatrics, R. N. T. Medical College, Udaipur, Rajasthan, India

Junior Resident

Department of Pediatrics

RNT Medical College, Udaipur

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Published

2020-09-21

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Original Research Articles