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KMID : 0378019600030080085
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New Medical Journal
1960 Volume.3 No. 8 p.85 ~ p.90
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Clinical Observation of Tuberculous Meningitis 100 Cases
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尹德鎭/Cho, Byong Kuk
趙炳菊/李昊國/Yun, Duk Jin/Lee, Ho Kuk
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Abstract
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Tuberculous meningitis had been regarded as a disease of almost a 100510 mortality rate before the introduction of streptomycine in 1947 by Ratner. With the therapeutic use of this drug alone 15% of cure-rate was observed until when another anti-tuberculous chemotherapeutic of PAS z:as discovered. The combined use of these two agents resulted in a 50% cure-rate for tuberculous meningitis. In 1952 iNH was introduced whose combined use with the other two agents resulted in an even more promising current cure-rate of 71%.
This is of course an encouraging figure;,-however in an underdeveloed community where people are provertystricken a halth insurance system is inconceivable and physicians are forced to compromise their ideal therapeutic plan with the economic status of their patients it is self-evident that to reach such a high cure rate is an impossibility.
We have made a clinical observation on a 100 cases of tuberculous meningitis treated at the Pediatric Dept. of Severance Hospital during the past three years from 1956 to 1958. Of this report makes any significant contribution to the better control of tuberculous meningitis our aim be accomplished. The result of the observation is summerized as follows:
(1) The common age group of tuberculous meningitis
was 1-5 years. The peak is in the age group of 2years. The diseases was more common in male children the ratio being 3 : 1. The disease seemed to have its prevalence in the lower income group.
(2) The incidence was higher during the spring and
summer seasons and the longer the time between the onset and admission the worse the prognosis became.
(3) The related number of fatal cases in each age group indicated that the disease is more fatal to younger gae group there was no difference between female and male in fatality rate. The fatality rate was highest among the patients to whom chemotherapy was instituted more than one month after the onset indicating the necessity of early treatment.
(4) Early symptoms observed were, in the order of frequency, nausea & vomitting, coevulsiop-, fever, headache, unconsciousness, abdominal pain, opisthotonus & speech disturbance.
(5) The over all fatality rate was 3%. Recurrences were o gserved in 4 out of 61 cases followed. Among 18 survivers 7 cases were completely cured. The fate of 43 cases was not known.
(a) Among 11 cases in whom Streptomycine was used, deaths were observed.
(b) Among 6 cases in whom´ Streptomycine was used in combination with INH, 3 deatlis´were observed.
(c) Among 17 cases in whew either Streptomycine INH or INH with PAS was used, 9 deaths were observed.
(d) Among 41 cases in whom all three drugs were used in combination, 13, deaths were observed.
(e) Among 8 cases to whom ACTH was administered in conjunction with PAS Streptomycine, & IN11, 2 deaths were observed.
(f) Among 17 cases to whom Cortisone was administered in conjunction with PAS, Streptomycine & INH, 3 deaths were observed.
(g) The sequelae among the surviors were, hydrocep halus, optic atrophy, speech disturbance, mental retardation, spastic paralysis and intractable headache.
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