Supportive care needs for children with central nervous system TB
| System | Supportive care requirements |
| Airway and lung protection | Positioning—15–30° head up Oral suctioning Nasogastric feeding Chest physiotherapy Glycopyrrolate if excessive watery secretions requiring frequent suctioning |
| Nutrition | Regular nutritious feeding using standard formula or F75/F100 if malnourished Calculate and review daily caloric requirement Micronutrients Iron supplementation if likely iron deficiency anaemia (low Hb, low mean red cell volume, high red cell distribution width) |
| Intracranial hypertension and hydrocephalus | Nurse at incline 30° head up Ensure euvolaemia Dexamethasone reduces oedema around ring-enhancing lesions CT scan if available to diagnose hydrocephalus or tuberculoma Acetazolamide, frusemide if hydrocephalus identified Consider ventriculoperitoneal shunt Oxygen and mannitol if acute deterioration |
| Contractures and wasting | Ideally physiotherapists will design a programme of exercises, and teach the parents, ensuring a full range of joint movement Early mobilisation in wheelchair Nutrition Baclofen and gabapentin for severe spasticity (low-dose diazepam if baclofen not available) |
| Electrolyte imbalance | Avoid prolonged use of intravenous fluids Avoid hypotonic intravenous solutions Regular checking of serum [Na+] when patient on intravenous fluids Nasogastric or oral soup feeding |
| Prevention of hospital-acquired infections | Hand washing Intravenous site care Pulmonary suctioning Avoid prolonged bladder catheterisation Avoid unnecessary antibiotics |
| Seizure prevention and control | Phenobarbitone Distinguish cortical seizures requiring anticonvulsants from dystonia or athetoid movements Avoid oversedation |
| Pressure areas | Regular turning, massage, daily inspection of bony prominences |
| Dental and oral hygiene | Chlorhexidine mouth wash Cleaning of teeth regularly, dental review Oral nystatin for prevention of mucosal candidiasis |
| Gastric ulceration | H2-receptor antagonist to reduce gastric acid production (when on corticosteroids) Feeding protection |
| Constipation and gastrointestinal health | Regular lactulose/Movicol (macrogol) Fruits and vegetables in diet Consider probiotics |
| Urinary retention | Intermittent catheterisation if needed Prevention of urinary tract infection |
| Monitoring | Glasgow Coma Score Oxygen saturation using pulse oximetry Temperature Weight twice weekly, plus MUAC Head circumference |
| Diagnostic issues | Diagnostic specificity, when there is limited neurological recovery due to established brain injury, multidrug resistance, or other causes Where GeneXpert test available, CSF can be tested to investigate for drug-resistant TB |
| Adverse treatment effects | TB drug side effects—check for jaundice Pyridoxine for INH-related peripheral neuropathy Monitor for ethambutol eye toxicity Monitor for hearing loss if on aminoglycosides for MDR TB |
| Staff infection protection | P2 masks Hand washing |
CNS, central nervous system; CSF, cerebrospinal fluid; Hb, haemoglobin; INH, isoniazid; MDR, multidrug resistant; MUAC, mid-upper arm circumference; TB, tuberculosis.