CHILDHOOD TUBERCULAR MENINGITIS: INSIGHTS INTO CLINICAL PRESENTATION, RADIOLOGICAL FINDINGS, AND OUTCOME DETERMINANTS

Introduction: Childhood tuberculosis (TB) in India affects around 342,000 children annually, with a detection gap of 56%, and includes significant cases of extra-pulmonary TB like tuberculous meningitis (TBM). TBM has high mortality and morbidity rates due to diagnostic challenges such as vague symptoms and difficulties in obtaining samples. This study aims to evaluate TBMs clinical and radiological profiles in children to improve diagnostic and therapeutic outcomes and enhance prognosis in high-burden settings. Methodology: This prospective observational study at Government Medical College Srinagar enrolled 30 children under 18 years suspected of TBM, based on prolonged fever, cough, and neurological signs, excluding those already on treatment or with chronic illnesses. Diagnostic tests included chest X-ray, Mantoux test, hemogram, CSF analysis, neuroimaging, and HIV testing, with patients classified using the Marais et al. TBM scoring system. Statistical analysis identified mortality-related factors, using descriptive statistics, comparative analyses, and logistic regression to adjust for confounders. Results: This study examined 30 pediatric patients with tubercular meningitis (TBM) at GMC Srinagar, revealing an average age of 6.65 years and a slight female predominance (53.3%). Common clinical features included fever (83.3%), altered sensorium (56.7%), and seizures (53.3%), with 93.3% showing meningeal irritation and 56.7% exhibiting raised intracranial pressure. CSF analysis showed elevated protein and decreased glucose levels imaging revealed meningeal enhancement (70%) and hydrocephalus (46.7%). Key factors influencing outcomes included BCG vaccination reducing mortality and advanced TBM stages, seizures, and hydrocephalus increasing mortality risks. Conclusion: our study highlights critical clinical, radiological, and socioeconomic insights into pediatric TBM. Key findings include the prominence of neurological symptoms, the crucial role of MRI in diagnosis, and the influence of socioeconomic status on disease burden. These insights emphasize the need for early diagnosis, vigilant monitoring, and targeted management to improve outcomes and reduce neurological complications.