Comparative study of clinical manifestations in pediatric tuberculous meningitis versus Listeria monocytogenes meningitis

Differentiating tuberculous meningitis (TBM) from Listeria monocytogenes meningitis (LMM) is challenging. Misdiagnosis leads to inappropriate treatment, high mortality, and severe disability. Analyzing their clinical differences is crucial for early diagnosis, precise treatment, and reducing mortality. This study aimed to compare the clinical, laboratory, and radiological features of pediatric TBM and LMM patients to improve early differentiation and guide treatment. We retrospectively analyzed 33 TBM and 41 LMM patients from Beijing Children’s Hospital (2010–2022). Clinical presentations, laboratory results, neuroimaging results, and outcomes were compared. LMM patients were younger (median 2.3 vs. 4.5 years, p < 0.001) and had a higher proportion of diarrhea ( p < 0.001). TBM patients had higher rates of neurological deficits ( p < 0.05) and worse outcomes ( p = 0.001). TBM presented with lower serum C-reactive protein (CRP), procalcitonin (PCT), and white blood cell (WBC) counts. Cerebrospinal fluid (CSF) leukocytosis was greater in LMM patients ( p < 0.001), with lower chloride in TBM patients ( p < 0.001). Basal meningeal enhancement (42.4% vs. 0%) and tuberculoma (15.2% vs. 0%) are the characteristic findings of TBM, whereas LMM is characterized mainly by convexity meningeal enhancement (65.8% vs. 18.2%). CSF culture positivity was greater in LMM than in TBM (82.9% vs. 3.0%). Molecular testing in CSF was positive in 100% (7/7) of LMM patients and 77.8% (7/9) of TBM patients. TBMs and LMMs are clinically similar. However, TBM patients are older, and have more impaired consciousness, lower blood inflammation marker levels, lower CSF chloride levels, and characteristic imaging findings. LMM is associated with more diarrhea. Combining CSF culture with molecular detection improves pathogen identification and aids early diagnosis.