Tuberculous Meningitis in Male Child and Cavitary Pulmonary Tuberculosis in Mother: Concurrent Familial Infective Disease as Evidence of Recent Transmission from Mother to Baby!

Abstract

Tuberculosis (TB) is one of the leading causes of mortality in children worldwide, but there remain significant challenges in diagnosing and treating TB infection and disease. Tuberculous (TB) meningitis is the commonest infectious disease of the central nervous system in paediatric and geriatric cases. Childhood TB is an indication of failing TB control in the community. It allows disease persistence in the population. Tuberculosis can be prevented in children by diagnosing and treating cases of active TB amongst adults, as paediatric cases always acquire it passively from household contact of adults suffering from TB as disease in adults is multibacillary. Although significant data is available for the prevention of childhood extra-pulmonary and disseminated TB, offering Bacillus Calmette-Guerin (BCG) vaccination, it is still not routinely offered during vaccination. In this case report, a two-year child with a history of failure to thrive and constitutional symptoms diagnosed with disseminated extra-pulmonary TB presenting as TB meningitis with a history of contact with the mother suffering from active sputum positive pulmonary TB receiving anti-TB treatment. Child was evaluated with CT brain plain and contrast and documented meningeal enhancement. Cerebrospinal fluid analysis revealed tuberculous etiology in presence of lymphocytic predominance and raised ADA level in fluid. CSF fluid sent for cartridge based nucleic acid amplification test documented MTB genome with rifampicin sensitivity. We retrospectively analysed mothers’ sputum examination and observed higher grades of sputum AFB and her cartridge based nucleic acid amplification test revealed MTB genome with rifampicin sensitivity. Child and mother were treated with standard protocol recommended by NTEP (National Tuberculosis elimination program). In conclusion, we recommend BCG vaccination to all newborns, and tuberculin skin testing and isoniazid prophylaxis to the contact of adults with sputum positive pulmonary TB cases in India to prevent transmission of disease from mother to baby. A high index of suspicion is must while evaluating these cases and all possible measures should be taken to confirm tuberculosis to have successful treatment outcome.