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 discussed and a colleague tells you that there is contradictory evidence about the efficacy of neonatal BCG vaccination against pulmonary tuberculosis. You question the efficacy of neonatal BCG vaccination against tuberculous meningitis.

Structured clinical questions

How protective is BCG vaccination with regard to tuberculous meningitis?

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