Tuberculous Meningitis in Children *

In January, 1944, Schatz, Bugie, and Waksman' reported the isolation of a new antibacterial substance which was designated as streptomycin. In December, 1944, Feldman and Hinshaw' reported their observations on the suppressive effect of streptomycin on the human variety of microbacterium tuberculosis in guinea pigs. In January, 1946, Cooke, Dunphy, and Blake' reported in this Journal the first human case of tuberculous meningitis treated with streptomycin. At the time the article was published the patient had been observed for four months after therapy had been discontinued. She is still alive six years after the first therapy was given, she has had no relapses, and has received no further streptomycin after the initial 68 days of treatment.n From January 1, 1947, to January 1, 1951, fifty-six patients on whom a clinical diagnosis of tuberculous meningitis was made were seen at this hospital. This diagnosis was bacteriologically proven on thirty-seven patients who were treated, and the series is reported in detail (Table 1). An additional five were proven but died before receiving treatment, and fourteen had strong supporting evidence for the diagnosis of tuberculous meningitis, but the spinal fluid proof could not be obtained. As the data were analyzed certain observations merited comment, namely, age of the patient, length of illness prior to admission to the hospital, the clinical status of the patient when therapy was started, latent period prior to institution of therapy, and the presence or absence of miliary tuberculosis. Twenty (54%o) of the patients were two years of age or under. Of these, sixteen (80%o) were ill for two weeks or more; thirteen (65%o) were considered late, i.e., semicomatose or comatose, in the disease when therapy was started; twelve (60%o) had miliary tuberculosis. All twenty patients had one or more of these factors complicating their illness; all of these patients died.