TB Meningitis (TBM) can be devastating for children, leading to death or permanent disability, yet the disease can be prevented and treated if caught in time.
Stellenbosch University (SU) research has shown that only 15% of children admitted to Cape Town's Tygerberg Children's Hospital with TBM are in the early stage of the disease. By the time most children with TBM 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 Prof Regan Solomons, an associate professor at SU's Faculty of Medicine and Health Sciences (FMHS) and paediatric neurologist at Tygerberg Children's Hospital. He has recently investigated ways of improving the early and more accurate diagnosis of TBM in children.
The incidence of TBM in the Western Cape is amongst the highest in the world, with 50 children with TBM admitted to Tygerberg Children's Hospital every year.
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 behavioural problems and blindness, says Solomons.
Solomons completed his PhD focusing on TBM in Amsterdam after doing a joint PhD degree through the Department of Paediatrics and Child Health at the FMHS and Vrije University in the Netherlands. It was one of the first joint PhDs to be awarded by the two universities.
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 detecting TB.
"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.
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 diagnosis.
"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.
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."
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."
From then on, children often require intense care, including physiotherapy, occupational therapy, wheelchairs and other aids.
Tygerberg Children's Hospital offers 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," says Solomons.
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."
Professor Mariana Kruger, Executive Head of Paediatrics and Child Health at Stellenbosch University, says she fully supports PhD graduates such as Prof Solomons in the important work they do.
"What is remarkable about PhD graduates such as Prof 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."
