Does neonatal BCG vaccination protect against tuberculous meningitis?
Three part question In [children suspected of having mycobacterial meningitis] does [a history of BCG vaccination or presence of BCG scar] influence [the likelihood of tuberculous meningitis]? Clinical scenario An 8 month old baby girl, of Eastern European parents, presents with a week long history of coryzal symptoms for which she has been taking oral antibiotics. She is pyrexial, irritable, and unwell on examination. She is admitted with a clinical diagnosis of meningitis and commenced on intravenous cefotaxime. A lumbar puncture is performed and microscopy reveals an elevated number of white cells (majority lymphocytes), low glucose, and protein of 0.9 g/l. She does not respond to conventional therapy and nothing is growing on CSF or blood culture. There is no history of contact with tuberculosis and she was vaccinated with a single dose of BCG at birth. She was an intrauterine growth retarded baby but had no subsequent problems. The possibility of tuberculous meningitis is discusse
