beseeww22w3wwwwwwww,nsdbfsjdbfwwwwwwwwww..pptx

mediacls,mdc,msdnfks/ndmad/casd fasldfas dfha. dfha. dfkhal/skdf aldhf /ahds f/kafsdf

1. Pediatric TB Meningitis A Comprehensive Overview

2. Introduction Tuberculous meningitis (TBM) is a severe form of TB affecting the brain Common in children, especially in TB-endemic regions High morbidity and mortality if not diagnosed and treated early Challenges in diagnosis and management

3. Epidemiology Global prevalence: Higher in low and middle-income countries Age distribution: Most common in children under 5 years Risk factors: Malnutrition, HIV co-infection, overcrowding Seasonal variations: More common in certain seasons in some regions

4. Pathogenesis Primary infection: Inhalation of Mycobacterium tuberculosis Dissemination: Hematogenous spread to the meninges Formation of Rich foci: Subpial or subependymal foci Rupture into subarachnoid space: Leads to meningitis

5. Clinical Presentation Early symptoms: Fever, headache, vomiting, irritability Neurological symptoms: Seizures, altered consciousness, focal deficits Meningeal signs: Neck stiffness, positive Kernig's and Brudzinski's signs Systemic symptoms: Weight loss, night sweats, cough

6. Diagnostic Challenges Non-specific symptoms: Similar to other forms of meningitis Low sensitivity of CSF tests: AFB smear and culture Limited availability of advanced diagnostic tools: PCR, GeneXpert Delay in seeking medical care: Leads to advanced disease at presentation

7. Diagnostic Criteria Clinical criteria: Symptoms and signs suggestive of TBM CSF criteria: Lymphocytic pleocytosis, low glucose, high protein Imaging criteria: Hydrocephalus, basal enhancement, infarcts on CT/MRI Microbiological criteria: Positive AFB smear, culture, or PCR

8. CSF Analysis Cell count: Lymphocytic pleocytosis (100-500 cells/mm³) Glucose: Low (<40 mg/dL or <2.2 mmol/L) Protein: High (100-500 mg/dL) AFB smear and culture: Low sensitivity but highly specific

9. Imaging Studies CT scan: Hydrocephalus, basal enhancement, infarcts MRI: More sensitive for detecting meningeal enhancement and infarcts MRA: Useful for detecting vasculitis and vascular complications Ultrasound: Useful for detecting hydrocephalus in infants

10. Differential Diagnosis Bacterial meningitis: Acute onset, neutrophilic pleocytosis Viral meningitis: Milder symptoms, lymphocytic pleocytosis Fungal meningitis: Chronic course, similar CSF findings Brain abscess: Focal neurological deficits, ring-enhancing lesion on imaging

11. Treatment Principles Early initiation of anti-TB drugs: Isoniazid, Rifampicin, Pyrazinamide, Ethambutol Adjunctive steroids: Dexamethasone to reduce inflammation and complications Supportive care: Hydration, nutrition, seizure control Monitoring and follow-up: Regular clinical and laboratory assessments

12. Anti-TB Drugs First-line drugs: Isoniazid, Rifampicin, Pyrazinamide, Ethambutol Duration: 2 months intensive phase, 10 months continuation phase Dosage: Weight-based dosing, adjust for renal and hepatic function Monitoring: Liver function tests, complete blood count

13. Adjunctive Steroids Dexamethasone: Reduces inflammation and complications Dosage: 0.4 mg/kg/day for 4 weeks, then tapered over 4 weeks Benefits: Reduces mortality and neurological sequelae Side effects: Hyperglycemia, hypertension, immunosuppression

14. Supportive Care Hydration: Maintain fluid and electrolyte balance Nutrition: Adequate caloric intake to support growth and recovery Seizure control: Antiepileptic drugs if seizures occur Physiotherapy: To prevent and manage neurological sequelae

15. Monitoring and Follow-up Clinical assessments: Neurological examination, growth monitoring Laboratory tests: Liver function tests, complete blood count Imaging studies: Repeat CT/MRI to assess response to treatment Follow-up: Regular outpatient visits to monitor progress and adjust treatment

16. Complications Neurological sequelae: Seizures, hemiparesis, hydrocephalus Cognitive impairment: Learning difficulties, behavioral problems Hearing loss: Sensorineural hearing loss Visual impairment: Optic atrophy, cortical blindness

17. Prognosis Early diagnosis and treatment: Improves outcomes Stage of disease: Better prognosis in early stages Age: Worse prognosis in younger children Nutritional status: Better prognosis in well-nourished children

18. Prevention BCG vaccination: Protects against severe forms of TB Chemoprophylaxis: Isoniazid preventive therapy for contacts Infection control: Reduce transmission in healthcare settings Community education: Raise awareness about TB and its prevention

19. Research and Innovation New diagnostic tools: Improve sensitivity and specificity Novel therapeutic agents: Shorter and more effective treatment regimens Vaccine development: More effective vaccines than BCG Clinical trials: Evaluate new interventions in pediatric TBM

20. Case Studies Case 1: 3-year-old with fever, headache, and vomiting Case 2: 6-month-old with seizures and altered consciousness Case 3: 10-year-old with hydrocephalus and focal deficits Case 4: 1-year-old with TBM and HIV co-infection

21. Case Study 1 3-year-old with fever, headache, and vomiting for 2 weeks CSF: Lymphocytic pleocytosis, low glucose, high protein CT scan: Hydrocephalus and basal enhancement Treatment: Anti-TB drugs and adjunctive steroids

22. Case Study 2 6-month-old with seizures and altered consciousness CSF: Lymphocytic pleocytosis, low glucose, high protein MRI: Meningeal enhancement and infarcts Treatment: Anti-TB drugs, adjunctive steroids, and antiepileptic drugs

23. Case Study 3 10-year-old with hydrocephalus and focal deficits CSF: Lymphocytic pleocytosis, low glucose, high protein CT scan: Hydrocephalus and basal enhancement Treatment: Anti-TB drugs, adjunctive steroids, and VP shunt

24. Case Study 4 1-year-old with TBM and HIV co-infection CSF: Lymphocytic pleocytosis, low glucose, high protein CT scan: Hydrocephalus and basal enhancement Treatment: Anti-TB drugs, adjunctive steroids, and antiretroviral therapy

25. Conclusion Early diagnosis and treatment are crucial for improving outcomes Multidisciplinary approach: Involve pediatricians, neurologists, infectious disease specialists Continued research and innovation: Improve diagnostic tools and treatment options Prevention: BCG vaccination, chemoprophylaxis, infection control, and community education