Clinical presentations, diagnosis, mortality and prognostic markers of tuberculous meningitis in Vietnamese children: a prospective descriptive study

Abstract

BackgroundTuberculous meningitis in adults is well characterized in Vietnam, but there are no data on the disease in children. We present a prospective descriptive study of Vietnamese children with TBM to define the presentation, course and characteristics associated with poor outcome.MethodsA prospective descriptive study of 100 consecutively admitted children with TBM at Pham Ngoc Thach Hospital, Ho Chi Minh City. Cox and logistic regression were used to identify factors associated with risk of death and a combined endpoint of death or disability at treatment completion.ResultsThe study enrolled from October 2009 to March 2011. Median age was 32.5 months; sex distribution was equal. Median duration of symptoms was 18.5 days and time from admission to treatment initiation was 11 days. Fifteen of 100 children died, 4 were lost to follow-up, and 27/81 (33 %) of survivors had intermediate or severe disability upon treatment completion. Microbiological confirmation of disease was made in 6 %. Baseline characteristics associated with death included convulsions (HR 3.46, 95CI 1.19–10.13, p = 0.02), decreased consciousness (HR 22.9, 95CI 3.01–174.3, p < 0.001), focal neurological deficits (HR 15.7, 95CI 1.67–2075, p = 0.01), Blantyre Coma Score (HR 3.75, 95CI 0.99–14.2, p < 0.001) and CSF protein, lactate and glucose levels. Neck stiffness, MRC grade (children aged >5 years) and hydrocephalus were also associated with the combined endpoint of death or disability.ConclusionsTuberculous meningitis in Vietnamese children has significant mortality and morbidity. There is significant delay in diagnosis; interventions that increase the speed of diagnosis and treatment initiation are likely to improve outcomes.

Epidemiological, clinical characteristics and drug resistance situation of culture-confirmed children TBM in southwest of China: a 6-year retrospective study

“…Fever (90.5%), headache (71.4%) and cough (45.2%) were the most common symptoms, while more severe symptoms like neck stiffness, vomiting, and disturbance of consciousness were present in 35/42 (83.3%), 22/42(52.4%), and 14/42 (33.3%), respectively. The occurrence of these symptoms was similar or higher to those observed in previous studies [13][14][15][16]. In addition, children with TBM during hospitalization showed varying degrees of anti-tuberculosis druginduced hyperuricemia (23.8%) and hepatotoxicity (14.3%).…”

The aetiologies of central nervous system infections in hospitalised Cambodian children

“…GeneXpert) or culture was possible during the study period. It is possible that cases of TBM were missed, although Vietnamese children with probable or definite TBM had longer duration of symptoms before hospital review (median 19.5 days) than were seen in the current study [ 37 ]. Testing for Rickettsia spp.…”

The pathogenesis of tuberculous meningitis

“…In a pivotal study where adjunctive dexamethasone was found to decrease short term mortality in HIV‐1 uninfected patients with TBM, low glucose at presentation predicted poor outcome . In more recent studies, including those in children, CSF glucose, lactate, and protein levels have been linked to poor outcome . If these metabolic markers are simply markers of disease activity as in most forms of neurologic infection, then this finding is unsurprising.…”