Think central nervous system tuberculosis, also in low-risk children: a Danish nationwide survey

Cecilie Paulsrud, Anja Poulsen, Nadja Vissing, Peter H Andersen, Isik S Johansen, Ulrikka Nygaard


BACKGROUND: Paediatric central nervous system (CNS) tuberculosis (TB) imposes a high risk of death and neurologic sequelae, particularly if the diagnosis is delayed. Children from non-TB endemic countries are particularly at risk of delayed or missed diagnosis. We aimed to investigate CNS TB in Denmark, a TB low-endemic country and where Bacillus Calmette-Guerin (BCG) vaccination is not a part of the vaccination schedule.

METHODS: A nationwide retrospective case survey of all children with CNS TB in 2000-2015 identified through the National Danish TB Notification Register. We assessed epidemiology, clinical and paraclinical features, diagnostic criteria, treatment and outcome.

RESULTS: Nine ethnic Danes and 12 children from TB-endemic countries with CNS TB were identified. Clinical features, C-reactive protein, chest X-ray and indirect TB screening assays all had low sensitivity (19-75%). All (18/18) patients had elevated cerebrospinal fluid (CSF) white blood cells and 15 of 17 (88%) had a combination of at least two characteristic CSF findings (lymphocyte predominance, elevated protein and/or hypoglycorrhachia). Cerebral computed tomography and magnetic resonance imaging were abnormal in 10 of 16 (63%) and 12 of 14 (86%), respectively. Treatment was initiated after a median of 3 days in children from TB-endemic countries, and after 10 days in ethnic Danish children. One patient died (5%): A native Danish girl who died before the diagnosis was established.

CONCLUSIONS: Children from non-TB endemic countries may be at risk of delayed diagnosis and poorer prognosis compared to high-risk children. Cerebral magnetic resonance imaging and characteristic CSF findings had high diagnostic sensitivity.

Original languageEnglish
JournalInfectious diseases (London, England)
Issue number5
Pages (from-to)368-372
Number of pages5
Publication statusPublished - 2019


  • Adolescent
  • Anti-Bacterial Agents/therapeutic use
  • BCG Vaccine
  • Child
  • Child, Preschool
  • Delayed Diagnosis
  • Denmark/epidemiology
  • Ethnic Groups
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Magnetic Resonance Imaging
  • Male
  • Mycobacterium tuberculosis/pathogenicity
  • Registries
  • Retrospective Studies
  • Risk Factors
  • Surveys and Questionnaires
  • Tuberculosis, Central Nervous System/diagnostic imaging
  • Vaccination/statistics & numerical data


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