HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS REGISTER		Author Keyword(s) Vol Page [Advanced]

This Article Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this link to a friend Similar articles in this journal Similar articles in PubMed Add article to my folders Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kumar, R Articles by Kohli, N Search for Related Content PubMed PubMed Citation Articles by Kumar, R Articles by Kohli, N Topic Collections Relevant Article

Tuberculous meningitis in BCG vaccinated and unvaccinated children

¹ Department of Pediatrics, King George Medical University, Lucknow, India
² Department of Radiodiagnosis, King George Medical University, Lucknow, India

Correspondence to:
Correspondence to:
Professor R Kumar
HIG 111, Sec E, Aliganj, Lucknow (UP), India 226003; rashmik{at}sancharnet.in

Background: A modified clinical presentation of tuberculous meningitis (TBM) in children vaccinated with BCG has been described in the literature. However, most reports are old and not based on actual comparisons and tests of significance. Also, neuroimaging features were not compared. With large scale BCG coverage, it becomes pertinent to describe the "modified" presentation and identify any significant differences between vaccinated and unvaccinated children with TBM.

Methods: A total of 150 consecutive hospitalised children (96 unvaccinated, 54 vaccinated) were enrolled. They all satisfied predefined criteria for diagnosis of TBM. Clinical and radiological features of children with/without a BCG scar were compared.

Results: Univariate analysis revealed that the vaccinated children with TBM had significantly lower rates of altered sensorium (68.5% v 85.4% unvaccinated; OR 2.2 (1.1 to 6.2); p = 0.019) and focal neurological deficits (20.3% v 39.5% unvaccinated; OR 2.6 (1.1 to 6.0); p = 0.016), and higher mean (SD) Glasgow Coma Scale score (10.2 (3.4) v 8.76 (2.7) unvaccinated; p = 0.010) and cerebrospinal fluid cell count (210.9 v 140.9 unvaccinated; p = 0.019). No significant radiological differences were seen. Short term outcome was significantly better in the vaccinated group with 70% of the total severe sequelae and 75% of the total deaths occurring in the unvaccinated group (p = 0.018).

Conclusion: Children with TBM who have been vaccinated with BCG appear to maintain better mentation and have a superior outcome. This may in part be explained by the better immune response to infection, as reflected in the higher CSF cell counts in this group in the present study.

Abbreviations: BCG, bacille Calmette Guérin (vaccine); CSF, cerebrospinal fluid; TBM, tubercular meningitis

Keywords: BCG vaccination; tuberculous meningitis

Relevant Article

BCG vaccination and severity of childhood tuberculous meningitis

V Rajshekhar
J. Neurol. Neurosurg. Psychiatry 2005 76: 1470. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

				R. B. Rock, M. Olin, C. A. Baker, T. W. Molitor, and P. K. Peterson Central Nervous System Tuberculosis: Pathogenesis and Clinical Aspects Clin. Microbiol. Rev., April 1, 2008; 21(2): 243 - 261. [Abstract] [Full Text] [PDF]

				M A Anjay and P Anoop Tuberculous meningitis: more evidence for protective effect of BCG Arch. Dis. Child., March 1, 2007; 92(3): 277 - 277. [Full Text] [PDF]

				Lucina Arch. Dis. Child., December 1, 2005; 90(12): 1320 - 1320. [Full Text] [PDF]