Tuberculous meningitis (TBM) occurs mainly in developing
countries where tuberculosis (TB) is more common and the wider
incidence of the human immunodeficiency virus (HIV) favors the
onset of a great number of cases. However, TBM is also encountered
in industrialized countries, particularly in recent years, as a consequence
of the large immigration of infected people1 and the
frequent use of biological agents that favor TB development.2,3
Children are among the subjects who most frequently suffer from
TBM due to their relative inability to contain primary Mycobacterium
tuberculosis infection in the lung.1,3 TBM is a devastating
disease with about 30% mortality in the most severe forms;
moreover, 50% of survivors have neurological sequelae despite
apparently adequate administration of antibiotics.4,5 Early diagnosis
and prompt treatment are crucial for reducing the risk of
a negative evolution. However, especially in children, the best and
most rapid way to diagnose the disease is controversial; the
optimal choice, dose, and treatment duration of anti-tuberculosis
drugs are not precisely defined, and the actual importance of
adjunctive therapies with steroids and neurosurgery have not been
adequately demonstrated. Consequently, the approach to pediatric
TBM is frequently inadequate. This review is aimed at discussing
present knowledge on the diagnosis and treatment of pediatric
TBM in order to offer the best solution to address this dramatic
disease.