Table 1

Supportive care needs for children with central nervous system TB

SystemSupportive care requirements
Airway and lung protectionPositioning—15–30° head up
Oral suctioning
Nasogastric feeding
Chest physiotherapy
Glycopyrrolate if excessive watery secretions requiring frequent suctioning
NutritionRegular nutritious feeding using standard formula or F75/F100 if malnourished
Calculate and review daily caloric requirement
Iron supplementation if likely iron deficiency anaemia (low Hb, low mean red cell volume, high red cell distribution width)
Intracranial hypertension and hydrocephalusNurse 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 wastingIdeally physiotherapists will design a programme of exercises, and teach the parents, ensuring a full range of joint movement
Early mobilisation in wheelchair
Baclofen and gabapentin for severe spasticity (low-dose diazepam if baclofen not available)
Electrolyte imbalanceAvoid 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 infectionsHand washing
Intravenous site care
Pulmonary suctioning
Avoid prolonged bladder catheterisation
Avoid unnecessary antibiotics
Seizure prevention and controlPhenobarbitone
Distinguish cortical seizures requiring anticonvulsants from dystonia or athetoid movements
Avoid oversedation
Pressure areasRegular turning, massage, daily inspection of bony prominences
Dental and oral hygieneChlorhexidine mouth wash
Cleaning of teeth regularly, dental review
Oral nystatin for prevention of mucosal candidiasis
Gastric ulcerationH2-receptor antagonist to reduce gastric acid production (when on corticosteroids)
Feeding protection
Constipation and gastrointestinal healthRegular lactulose/Movicol (macrogol)
Fruits and vegetables in diet
Consider probiotics
Urinary retentionIntermittent catheterisation if needed
Prevention of urinary tract infection
MonitoringGlasgow Coma Score
Oxygen saturation using pulse oximetry
Weight twice weekly, plus MUAC
Head circumference
Diagnostic issuesDiagnostic 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 effectsTB 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 protectionP2 masks
Hand washing
  • CNS, central nervous system; CSF, cerebrospinal fluid; Hb, haemoglobin; INH, isoniazid; MDR, multidrug resistant; MUAC, mid-upper arm circumference; TB, tuberculosis.