The effect of streptomycin on tuberculous meningitis.

Abstract

The recent literature contains many detailed reports on the therapeutic effects of streptomycin in tuberculosis in its various clinical forms, but pathological studies of streptomycin-treated tuberculosis. are fewer, the first detailed account being that by Baggenstoss and his coworkers (1) (five cases). In this work we have studied the pathologic findings in tuberculous meningitis and the associated generalized miliary tuberculosis in 26 cases in which streptomycin was therapeutically employed. From February, 1947 to February 1949, 38 infants and children with tuberculous meningitis were treated with streptomycin at the Children's Division of Cook County Hospital (Chicago). Seven of these made apparent recoveries; complicated by hemiparesis in one case and deafness in two. One patient whose treatment was started on February 23, 1947, is still alive and represents the longest survival period in this series. Of the 38 children in this series, 23 came to necropsy, and with the addition of three other cases (two being adults) treated in another division of the Cook County Hospital, form the basis of this study. Treatment consisted of intramuscularly administered streptomycin, usually 0.2 Gm. every three hours. No intrathecal therapy was given except to our firstpatient (Case 10) who received nine intraspinal injections, and two patients (Cases 19 and 25) who had received previous treatment at other Chicago hospitals, including 23 and 24 intrathecal injections, respectively. Treatment was continued for at least 90 days unless the patient did not survive that long; in addition, if a relapse occurred, further streptomycin was given until death.