Zapalenie opon mózgowo-rdzeniowych o charakterze gruźliczym u dzieci: rozpoznanie, przebieg kliniczny i wyniki w czasach współczesnych

Tuberculous meningitis (TBM) is a critically severe form of extrapulmonary tuberculosis in pediatric patients. Presents a significant diagnostic challenge during the early stages of clinical manifestation. Delayed recognition of meningeal tuberculous inflammation leads to the involvement of the brain parenchyma (encephalitis) and may result in irreversible neurological sequelae. Objective: To evaluate the clinical features, the spectrum of complications, and the outcomes of tuberculous meningitis in pediatric patients under current epidemiological conditions. Materials and Methods: A retrospective analysis of 21 medical records was conducted for pediatric patients aged 3 months to 17 years (mean age: 6.7 ± 5.8 years) with a confirmed TBM diagnosis. The study included pediatric patients treated in the tuberculosis department or evaluated through the telemedicine consultation system between January 2017 and May 2025. Results: A history of contact with a tuberculosis patient was established in 62% (13/21) of cases. At initial presentation, fever was recorded in 67% (14/21) of patients, headache and nausea/vomiting in 52% (11/21), and meningeal signs in 38% (8/21). The majority of patients (52%, 11/21) had not received BCG vaccination. Mycobacterium tuberculosis (MBT) was identified in 19 patients (90%). MTB DNA was detected in the cerebrospinal fluid (CSF) in 79% of patients (15/21). Drug resistance (DR) was confirmed in 57.9% of patients (11/19), including MDR/XDR strains in 81.8% (9/11) of the DR subgroup. Complications included motor deficits in 38% (8/21), hydrocephalus in 47.6% (10/21), and epileptic syndrome in 19% (4/21). Four patients (19%) with an unfavorable outcomes were transitioned to palliative care. Conclusion: In pediatric patients; TBM delayed diagnosis results in a more severe clinical course characterized by the development of profound neurological deficits. This study demonstrates that TBM has evolved from a predominantly meningeal disease into a severe form of meningoencephalitis; frequently accompanied by hydrocephalus; epilepsy; and motor deficits. Notably; seizure disorder serves as a critical predictor of an unfavorable outcome. These findings underscore the urgent need to optimize early diagnostic strategies within general healthcare networks.