Although early and rapid identification of TBM is crucial for
successful disease management, in most of the cases, diagnosis is
significantly delayed. Initial signs and symptoms of disease are
non-specific and the suspicion of TBM usually arises only some days
or weeks after the disease’s onset and is not different in children
who have or have not been vaccinated with Bacille Calmette-Guerin.6
Fever, headache, anorexia, and vomiting characterize the
prodrome of disease in older children, whereas failure to thrive,
poor appetite, vomiting, and sleep disturbances are more common
in younger ones.7 TBM is more easily suspected when these
symptoms are associated with a history of recent contact with
a case of documented TB or when, after the first days of disease,
relevant neurological manifestations, such as cranial nerve palsy,
occur.6,7