Shattering consequences of tuberculous meningitis described in new study
May/June 2025 | Volume 24 Number 3
Photo courtesy of Stellenbosch UniversityDr. Karen du Preez
Tuberculosis is one of the top 10 causes of death in children under the age of 5 globally. Young children, who have immature immune systems, are more likely to develop disseminated disease. Disseminated TB results when the immune system cannot control the spread of TB-causing bacteria and then cannot prevent the bacteria from growing in places like the central nervous system (in the case of TB meningitis).
Deadly when untreated, TB meningitis often causes death or disability even when treated. A Fogarty-funded study published in
The Lancet Global Health provides first-ever estimates of TB meningitis incidence, morbidity, and mortality in children.
Understudied scourge
“Working as a clinician in a high TB burden setting and seeing the devastating effects of TB meningitis on children and their families motivated me to do our study,” says Dr. Karen du Preez of South Africa’s Desmond Tutu Tuberculosis Centre, Stellenbosch University. She and her team created a mathematical model and analyzed the literature to assess the number of children up to age 14 affected by TB meningitis in 2019. They estimate 24,000 children developed the disease, most of them younger than 5 years old, while approximately half were diagnosed and treated. Among these children, TB meningitis resulted in 16,100 deaths in 2019 and had a case-fatality rate of 67%, higher than the estimated 19% overall tuberculosis mortality in children that year. “Having estimates of how many children are affected is an important first step to advocate for more resources to strengthen research and health systems to improve prevention, earlier diagnosis and treatment of children with TB meningitis,” says du Preez, a Fogarty Emerging Global Leader grantee.
Identification, diagnosis and treatment of the disease can be thorny, says Dr. Alexander Kay, who oversees clinical care at Baylor College of Medicine’s TB Centre of Excellence in Mbabane, eSwatini. “The initial symptoms of TB meningitis, which include fever, headache, and nausea or vomiting, overlap with common childhood illnesses.” Knowledge of a child’s exposure to TB would be helpful, but busy clinics are not always capable of recording patient histories. If a clinician suspects TB meningitis—usually after neurologic symptoms have developed—a diagnosis typically requires cerebrospinal fluid tests and brain imaging, which are unavailable in many settings. For these reasons, children frequently become lost to care before receiving a diagnosis. Among those diagnosed, the duration of therapy is long—longer than for most other forms of TB—plus children with TB meningitis often require neurosurgical care to prevent a build-up of fluid in the brain. Unable to swallow medication by mouth, children sometimes require the placement of nasogastric tubes. “In children who survive, the degree of disability can be profound.”
“TB meningitis can impact anyone, but mostly it impacts those without a voice,” says Kay, who did not contribute to the du Preez study. This includes “infants who have yet to speak” and those “without access to the care needed to prevent or treat TB meningitis,” particularly people with suppressed immune systems (due to medication or diseases like HIV).
Photo courtesy of NIAIDBacteria that causes TB
Eliminate TB
Kay believes awareness of this study is crucial for clinicians. If they understood how many children are affected and that this is a “fatal condition without treatment, it may spur them to initiate more diagnostic evaluations or start treatment early while working towards a definitive diagnosis.” Early detection can be achieved by robust case tracing programs to evaluate everyone with a recent TB exposure. “And ensuring that the Bacillus Calmette–Guérin (BCG) vaccine is given to all eligible newborns in countries where this vaccine is recommended can help reduce their risk of TB meningitis.” The study authors note that reporting TB meningitis in the surveillance data countries collect and send to WHO would also help.
Though most children impacted by TB meningitis are born in Africa or South-East Asia, Kay says the study findings also benefit American children. “Every year there are U.S. families whose children die or have lifelong disability resulting from this condition. Unless we eliminate TB, children will continue to suffer from TB meningitis. And until TB is eliminated, investing in research to improve diagnosis and treatment is absolutely needed to avoid devastating outcomes.”
More information
Updated June 18, 2025
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