Lumbar Cerebrospinal Fluid Evolution in Childhood Tuberculous Meningitis

As early diagnosis of childhood tuberculous meningitis cannot rely on mycobacterial confirmation, clinical, cerebrospinal fluid and neuroimaging features are essential. We aimed to describe the evolution of serially analyzed lumbar cerebrospinal fluid parameters. We performed a retrospective observational study including children <13 years with suspected tuberculous meningitis at Tygerberg Hospital, Cape Town, South Africa. Cerebrospinal fluid parameters at admission and weeks 1, 2, and 3 were analyzed. Of 318 children with suspected tuberculous meningitis, 53 (17%) had “definite” tuberculous meningitis and 265 (83%) “probable” tuberculous meningitis. Longitudinal clustering revealed 3 distinct profiles, with 1 group atypically demonstrating initial increase in lymphocyte count, neutrophil count, and protein concentration. The decreasing cerebrospinal fluid glucose trend remained uniform among all groups. A gradual decline in cerebrospinal fluid lymphocyte, neutrophil and protein count, and rise in cerebrospinal fluid glucose concentration is expected; however, normal variability exists.