Resumen
La tuberculosis meníngea (TBM) es la manifestación extra-pulmonar más común de la infección por Mycobacterium tuberculosis y constituye un grave problema de salud pública en los países en desarrollo. El riesgo de progresión de tuberculosis primaria a TBM es mayor en los niños, principalmente en los menores de 5 años. Esta entidad representa el 20- 40% de todos los tipos de tuberculosis en los niños, comparada con 2.9 - 5.9% en adultos. A pesar de la terapia antituberculosa, la mortalidad y las secuelas neurológicas asociadas son muy altas. La literatura disponible acerca de los factores pronósticos, en países en desarrollo, es limitada.
Los principales factores de riesgo descritos para pobre pronóstico, incluyendo mortalidad, son el estadio III de la enfermedad, el coma profundo y la edad menor de 2 años; otros factores reportados, aunque no de manera consistente en la mayoría de las series, son las proteínas en el líquido cefalorraquídeo mayores de 100 mg/dL, la hipertonía, el manejo tardío de la hidrocefalia, la presencia de infartos cerebrales, el déficit focal al ingreso, la parálisis de nervios craneales y las convulsiones. En las series publicadas de TBM en niños, la mortalidad oscila entre el 7.5 % y el 22 %. En Colombia se ha reportado una mortalidad del 17%.
Citas
SOLARTE RA, CABRERA D, CORNEJO W. Meningoencefalitis tuberculosa en niños: Revisión de 35 casos en el Hospital Universitario San Vicente de Paúl en Medellín, Colombia.1997-2004. IATREIA 2005; 18: 385-395.
DYE C, SCHEELE S, DOLIN P, PATHANIA V, RAVIGLIONE MC. Consensus statement. Global burden of tuberculosis: estimated incidence, prevalence, and mortality by country. WHO Global Surveillance and Monitoring Project. JAMA 1999; 282:677-686.
PETO HM, PRATT RH, HARRINGTON TA, LOBUE PA, ARMSTRONG LR. Epidemiology of Extrapulmonary Tuberculosis in the United States, 1993-2006. Clinical Infectious Diseases 2009; 49:13501357.
VAN DER WEERT EM, HARTGERS NM, SCHAAF HS, ET AL. Comparison of diagnostic criteria of tuberculous meningitis in human immunodeficiency virus-infected and uninfected children. Pediatr Infect Dis J 2006; 25:65-69.
WALLS T,SHINGADIAC D, VAS N. The The epidemiology of paediatric tuberculosis inEurope. Current Paediatrics 2004; 14: 258-262.
FEJA K, SAIMAN L. Tuberculosis in children. Clin Chest Med 2005; 26:295-312.
ABBAS A, LICHTMAN A, PILLAI S. Células y tejidos del sistema inmune.En: Inmunología celular y molecular, 6a Ed. España. Elsevier Saunders 2008:47-72.
World Health Organization. Global tuberculosis control- surveillance, planning, financing. WHO Report 2010. Disponible en: http://whqlibdoc.who.int/publications/2010/9789241564069_eng.pdf
SWAMINATHAN S, REKHA B. Pediatric Tuberculosis: Global Overview and Challenges. Clinical Infectious Diseases 2010; 50(S3):S184-S194.
ARTEAGA A, VÉLEZ E, SALAZAR OF, MORALES OL, CORNEJO JW, VALENCIA DC. Características clínicas y socio-demográficas de niños menores de 13 años con diagnóstico confirmado de tuberculosis pulmonar o sin él, en el Hospital Universitario San Vicente de Paúl, Medellín, Colombia, 2007-2008. IATREIA 2010: 227-239.
SHIPLEY WR. Consumption in the 1990s: A Review of Tuberculosis. Antimicrobics and Infectious Diseases Newsletter 1996; 15: 1-6.
CHAPARRO PE, GARCIA I, GUERRERO MI, LEON CI. Situation of tuberculosis in Colombia, 2002. Biomédica 2004; 24:102-114.
SEGURA A, REY J, ARBELÁEZ M. Tendencia de la mortalidad y los egresos hospitalarios por Tuberculosis antes y durante la implementación de la reforma del sector salud en Colombia. 1985-1999" Biomédica 2004; 24 (Suppl): 115-123.
TINSA F, ESSADDAM L, FITOURI Z, BOUS-SETTA K, BEN BECHER S, BOUSNINA S. Central System Nervous Tuberculosis inInfants. Journal of Child Neurology 2010; 102-106.
DOERR CA, STARKE JR, ONG LT. Clinical and public health aspects of tuberculous meningitis in children. J Pediatr 1995; 127:27-33.
DONALD PR, SCHOEMAN JF. Tuberculous meningitis. N Engl J Med. 2004;351:1719-1720.
THWAITES G, FISHER M, HEMINGWAY C, SCOTT G, SOLOMON T, INNES J. British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system un adults and children. Journal of Infection. 2009;59:167-187.
YARAMIS A, GURKAN F, ELEVLI M, ET AL. Central nervous system tuberculosis in children: a review of 214 cases. Pediatrics 1998; 102: e49: 1-5.
THWAITES G, CHAU TT, MAI NT, DROB-NIEWSKI F, MCADAM K,FARRAR J. Tuberculous meningitis. J Neurol Neurosurg Psychiatry 2000;68:289-299.
LÓPEZ P, PRIETO A, CALA A, TRUJILLO J, CARRIZOSA J, CORNEJO JW. Utilidad de la medición de Adenosín Deaminasa en líquido cefalorraquídeo de niños con meningitis tuberculosa en un hospital colombiano 2001-2003. Acta Neurol Colomb 2008;24:151-157.
AHUJA GK, MOHAN KK, PRASAD K, BEHARI M. Diagnostic criteria for tuberculous meningitis and their validation. Tuber Lung Dis 1994; 75: 149-152.
SETH R, SHARMA U. Diagnostic criteria for tuberculous meningitis. Indian Journal of Pediatrics 2002: 299-303.
KUMAR R, SINGH SN, KOHLI N. A diagnostic rule for tuberculous meningitis. Arch Dis Child 1999; 81:221-224.
THILOTHAMMAL N, KRISHNAMURTHY PV, BANU K, RATNAM SR. Tuberculous meningitis in children-clinical profile, mortality and morbidity of bacteriologically confirmed cases. Indian Pediatr 1995; 32:641-647.
AHMADINEJAD Z, ZIAEE V, AGHSAEIFAR M, REISKARAMI SR. The Prognostic Factors of Tuberculous. The internet Journal of Infectious Disease. 2003; 3. Disponible en http://www.ispub.com
MISRA UK, KALITAJ, SRIVASTAVA M, MANDAL SK. Prognosis of tuberculous meningitis: a multivariate analysis. J Neurol Sci 1996; 137:57-61.
DI CARLO, CABIBI D, CASUCCIO A. MAZZOLA A, ROMANO A, TITONE L. Features in meningoencephalitis tubercular diagnosis: 18 chil-hood cases. American journal infectious diseases. 2008; 4:187-192.
KALITA J, MISRA UK, RANJAN P. Predictors of long-term neurological sequelae of tuberculous meningitis: a multivariate analysis. Eur J Neurol 2007; 14:33-37.
HUMPHRIES MJ, TEOH R, LAU J, GABRIEL M. Factors of prognostic significance in Chinese children with tuberculous meningitis. Tubercle. 1990; 71: 161-168.
CRUZ AT, STARKE JR. Clinical manifestations of tuberculosis in children. Paediatr Respir Rev 2007; 8:107-117.
PAGANINI H, GONZALEZ F, SANTANDER C, CASIMIR L, BERBERIAN G, ROSANOVA MT. Tuberculous meningitis in children: clinical features and outcome in 40 cases. Scand J Infect Dis 2000; 32:41-45.
COOVADIA YM, DAWOOD A, ELLIS ME, COOVADIA HM, DANIEL TM. Evaluation of adenosine deaminase activity and antibody to Mycobacterium tuberculosis antigen 5 in cerebrospinal fluid and the radioactive bromide partition test for the early diagnosis of tuberculosis meningitis. Arch Dis Child 1986; 61: 428-435.
CORNEJO W, PÉREZ J. Meningitis tuberculosa en niños: una revisión de aspectos clínicos, de laboratorio, epidemiológicos y terapéuticos y de la utilidad de la vacunación con BCG. IATREIA 2010; 23:250258.
THWAITES GE, SIMMONS CP, THAN HA, QUYEN N, THI HONG CHAU T, ET AL. Pathophysiology and prognosis in Vietnamese adults with tuberculous meningitis. J Infect Dis 2003; 188: 11051115.
KARANDE S, GUPTA V, KULKARNI M, JOSHI A. Prognostic clinical variables in childhood tuberculous meningitis: an experience from Mumbai, India. Neurol India 2005; 53:191-195.
MISRA UK, KALITA J, ROY AK, MANDAL SK, SRIVASTAVA M. Role of clinical, radiological, and neurophysiological changes in predicting the outcome of tuberculous meningitis: a multivariable analysis. J Neurol Neurosurg Psychiatry 2000; 68:300-303.
GIRGIS NI, FARID Z, KILPATRICK ME, SULTAN Y, MIKHAIL IA. Dexamethasone adjunctive treatment for tuberculous meningitis. Pediatr Infect Dis J 1991; 10:179-183.
KUMARVELU S, PRASAD K, KHOSLA A, BEHARI M, AHUJA GK. Randomized controlled trial of dexamethasone in tuberculous meningitis. Tuber Lung Dis 1994; 75:203-207.
SCHOEMAN JF, VAN ZYL LE, LAUBSCHER JA, DONALD PR. Effect of corticosteroids on intracra-nial pressure, computed tomographic findings, and clinical outcome in young children with tuberculous meningitis. Pediatrics 1997; 99:226-231.
SCHOEMAN JF, ELSHOF JW, LAUBSCHER JA, JANSE VAN, RENSBURG A, DONALD PR. The effect of adjuvant steroid treatment on serial cerebrospinal fluid changes in tuberculous meningitis. Ann Trop Paediatr. 2001; 21: 299-305.
ESCOBAR JA, BELSEY MA, DUENAS A, MEDINA P. Mortality from tuberculous meningitis reduced by steroid therapy. Pediatrics. 1975;6:1050-1055.
THWAITES GE, BANG ND, DUNG NH, QUY HT, TUONG DT, CAM NT, ET AL. N Engl J Med 2004;1741-1751.
DOOLEY D, CARPENTER JL. Adjunctive Corticosteroid Therapy for Tuberculosis: A Critical Reappraisal of the Literature. Clinical Infectious Diseases 1997;25:872-887.
SCHOEMAN JF, VAN ZYL LE, LAUBSCHER JA, DONALD PR. Serial CT scanning in childhood tuberculous meningitis: prognostic features in 198 cases. J Child Neurol 1995; 10:320-329.
ANDRONIKOU S, WILMSHURST J, HATHERILL M, VANTOORN R. Distribution of brain infarction in children with tuberculous meningitis and correlation with outcome score at 6 months. Pediatr Radiol 2006; 36:1289-1294.
VAN WELL GIJS TJ, PAES BF, TERWEE CB, SPRINGER P, ROORD JJ. Twenty Years of Pediatric Tuberculous Meningitis: A Retrospective Cohort Study in the Western Cape of South Africa. Pediatrics 2009: e1-e7.
SPRINGER P, SWANEVELDER S, VAN TOORN R, JANSE VAN RENSBURG A, SCHOEMAN J. Cerebral infarction and neurodevelopmental outcome in childhood tuberculous meningitis. European journal of paediatric neurology. 2009; 13: 343 -349.
WAECKER NJ, CONNOR J. Central nervous system tuberculosis in children: a review of 30 cases. The Pediatric Infectious Disease Journal. 1990:539-543.
ALTUNBA§AK S, ALHAN E, BAYTOK V, AKSA-RAY N, YÜKSEL B, ONENLI N. Tuberculous meningitis in children. Acta Paediatr Jpn. 1994;36:480-84.
PRICE HI, DANZIGER A. Computed tomography in cranial tuberculosis. AJR Am J Roentgenol 1978; 130:769-777.
ENG-KING TAN, MICHAEL WL CHEE, LING-LING CHAN, YAH-LENG LEE. Culture positive tuberculous meningitis: clinical indicators of poor prognosis. Clin Neurol Neurosurg 1999; 101: 157-160.
WALKER V, SELBY G, WACOGNE I. Does neonatal BCG vaccination protect against tuberculous meningitis? Arch Dis Child2006; 91:789-791.
RODRÍGUEZ LC, DIWAN VK, WHEELER JG. Protective effect of BCG against tuberculous meningitis and miliary tuberculosis: a meta-analysis. Int J Epidemiol 1993; 22: 1154-1158.
COLDITZ GA, BERKEY CS, MOSTELLER F, BREWER TF, WILSON ME, BURDICK E, ET AL. The efficacy of bacillus Calmette- Guerin vaccination of newborns and infants in the prevention of tuberculosis: meta-analyses of the published literature. Pediatrics 1995; 96: 29-35.
ROSENTHAL SR, LOEWINSOHN E, GRAHAM ML, LIVERIGHT D, THORNE G, JOHNSON V. BCG vaccination against tuberculosis in Chicago. A twenty-year study statistically analyzed. Pediatrics 1961; 28: 622-641.
KUMAR R, DWIVEDI A, KUMAR P, KOHL N. Tuberculous meningitis in BCG vaccinated and unvaccinated children. J Neurol Neurosurg Psychiatr. 2005; 76: 1550-1554.
KALITA J, MISRA UK. EEG changes in tuberculous meningitis: a clinicoradiological correlation. Electroencephalogr Clin Neurophysiol 1998; 107:39-43.
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