TB meningitis can be devastating for children, leading to death or
permanent disability, yet the disease can be prevented and treated if caught in
Stellenbosch University research has shown that only 15 percent of
children admitted to Cape Town’s Tygerberg Children’s Hospital with TB
Meningitis are in the early stage of the disease. By the time most children
with TB Meningitis are admitted to the hospital, they are already showing mildly
depressed levels of consciousness or have had strokes or fallen into a coma and
suffered brain damage.
“This is tragic, considering that TB Meningitis, if detected
early, is fully treatable with a completely normal outcome,” says Regan
Solomons, paediatric neurologist at the Tygerberg Children’s Hospital. He has
recently investigated ways of improving the early and more accurate diagnosis
of TB meningitis in children.
The incidence of TB Meningitis in the Western Cape is amongst the
highest in the world, with 50 children with TBM admitted to Tygerberg
Children’s Hospital every year.
Read: Can TB be cured?
While the hospital has the highest survival rate for TBM globally – at over 96% – children are often admitted too late to change their condition,
says Solomons. While they are likely to survive, their chances of a normal,
healthy life are dashed. Children aged two to four are particularly at risk.
Once TB has spread to the brain, it can result in permanent
disability, such as cerebral palsy, epilepsy, severe behaviour problems and
blindness, says Solomons.
Just a few droplets
Solomons completed his PhD focusing on TBM in Amsterdam after
doing a joint PhD degree through the Department of Paediatrics and Child Health
at Stellenbosch University and Vrije University in the Netherlands. It was the
first joint PhD ever awarded by the two universities.
TB is spread from an adult, often with the most common form of TB – pulmonary TB.
“It only takes a few droplets of a sneeze or cough for TB to
spread from an adult to a child. TB will first go to the lungs and then spread
to the brain, causing TB meningitis.”
Read: Open windows prevent TB
Solomons’ research has shown that chest X-rays do not necessarily
detect TB. Less than half of the 84 TBM patients in his study had a chest X-ray
“If the chest X-ray is normal, be vigilant, because it doesn’t
necessarily mean there’s no TB,” suggests Solomons. A lower concentration of
cerebrospinal fluid glucose distinguishes TBM from the less dangerous viral
meningitis. His research also showed that measuring blood glucose at the same
time could improve a diagnosis.
Clinics not picking up on TB diagnosis
Solomons says the first and most important step is for parents,
caregivers, doctors and nurses to be aware of the warning signs of TBM. This
can be difficult as the symptoms can often be similar to flu. But
Solomons says persistent symptoms should raise concern.
“If a child has a persistent cough, night sweats, vomiting, poor
appetite and if they’ve lost weight, TBM could be an option. It’s also very
important to ask if a child has come into contact with an adult with TB. TBM symptoms
tend to be longer than five days.”
Solomons is concerned that clinics are not picking up on a TB
Read: TB: get tested
“Children with TBM tend to have three or four contacts with health
professionals before they come to me. There are many lost opportunities at the
clinic. The thing that is often missed in clinics is when children
present with vomiting, and no diarrhoea.
“Sometimes it’s misdiagnosed as gastro, but you can’t have gastro
with only vomiting and no diarrhoea. If a child has persistent vomiting, it
could be a sign that there’s raised pressure in the brain somewhere and that
should make you worried.”
A child diagnosed with TB will be put on a six-month treatment of
a combination of four different drugs.
If not treated, decline can be sudden and shocking.
“It’s heartbreaking to see children that were healthy a few months earlier have permanent
neurological disabilities,” says Solomons.
“The parents come in and are totally in shock. Their child could
be ill for a while, but still playing and talking to them, and then all of a
sudden are lying there comatose. It often takes a few sit-down sessions with
the parents for the news to sink in.”
Read: Coma and persistent vegetative state
From then on, children often require intense care, including
physiotherapy, occupational therapy, wheelchairs and other aids.
Tygerberg Children’s Hospital is a tremendous support for children
with TBM. They often stay at the hospital for a month before going home. The
children follow up monthly at hospital until treatment is completed.
“The hospital is very caring and is a lifeline for many families,”
Solomons hopes for a world where ultimately people will not have
to face the risk of TBM.
“TBM can be eliminated if we can stop the spread of TB. We must
start with the kind of work the Desmond Tutu TB Centre at Stellenbosch
University is doing in raising awareness about preventing TB. I want to
encourage all South Africans to be aware of the signs and symptoms and stop TB,
so that children don’t have to suffer with TBM.”
Read: Better treatment for babies with TB
Professor Mariana Kruger, Executive Head of Paediatrics and Child
Health at Stellenbosch University, fully supports PhD graduates such as Dr
Solomons in the important work they do.
“What is remarkable about PhD graduates such as Dr Solomons is
that they are full-time clinicians, taking care of children on a daily basis
and successfully combining their research with active service delivery.”
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Prepared by Kim Cloete on behalf of the Department of Paediatrics
and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch
University. For more information or for an interview with Dr Regan Solomons,
contact Kim at firstname.lastname@example.org or 082 4150736.