Early Mortality among Immunocompetent Patients of Tuberculous Meningitis: A Prospective Study

Jaipuriar, Ravi Shekhar; Garg, Ravindra Kumar; Rizvi, Imran; Malhotra, Hardeep Singh; Kumar, Neeraj; Jain, Amita; Verma, Rajesh; Sharma, Praveen; Pandey, Shweta; Uniyal, Ravi

doi:10.4269/ajtmh.19-0098

Cited by 9 publications

(14 citation statements)

References 16 publications

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“…Although Glasgow coma scale has been introduced to evaluate the severity and predict the outcome of TBM 21 and a low Glasgow coma scale (GCS) score on admission was associated with a poor prognosis, the accurate criteria (score cut-off) for this is not well characterized. For example, GCS (score: 3-8) is thought as an independent predictor of poor outcome in TBM patients 22 ; the scale with ≤ 10 has a poor outcome 23 . In contrast, compared with Glasgow coma scale, coma as a symptom may be easy to use in the management of childhood TBM.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for poor outcome in childhood tuberculous meningitis

Wang

Zhao

Liu

2021

Sci Rep

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Tuberculous meningitis (TBM) remains a serious disease for children and its risk factors of poor outcome remain unclear. Therefore, a retrospective study was conducted aiming to investigate the risk factors associated with poor outcome of childhood TBM. Between January 2006 and December 2019, consecutive children patients (≤ 15 years old) who had a diagnosis of TBM were included for the analysis. The demographic, clinical, laboratory, and radiographic data were collected from the electronic medical records retrospectively. Poor outcome was defined as death or transfer to a higher-level hospital. Patients were then divided into good and poor outcome groups. Subsequently, risk factors for poor outcome were estimated using univariate and multivariate logistic regression analysis. A total of 149 children with TBM was enrolled, twenty-two patients suffered poor outcome, including 16 transfers to a higher-level hospital and 6 deaths, and the remaining 127 patients were classified as good outcome group. Further multivariate analysis revealed that coma (age- and sex-adjusted OR = 6.425, 95% CI: 1.743, 23.676; P < 0.01) and cerebrospinal fluid (CSF) protein (> 1188.3 mg/L; age- and sex-adjusted OR = 4.680, 95% CI: 1.469, 14.902; P < 0.01) were associated with the poor outcome of childhood TBM. Childhood TBM remains to have a high mortality rate in China. High CSF protein and coma were identified as risk factors for poor outcome of childhood TBM. Hence, more attention is required to be paid to suspected patients with such characteristics, thus facilitating access to optimum treatment.

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Section: Discussionmentioning

confidence: 99%

Risk factors for poor outcome in childhood tuberculous meningitis

Wang

Zhao

Liu

2021

Sci Rep

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“…While younger age and HIV coinfection were associated with microbiologically proven CNS-TB, older age was associated with increased mortality (34). Diabetes mellitus, chronic kidney failure, presence of hydrocephalus and microbiologically-confirmed CNS-TB were independent risk factors for increased mortality (19,32,(34)(35)(36)(37).…”

Section: Epidemiology Of Cns-tbmentioning

confidence: 99%

Neutrophil-Mediated Immunopathology and Matrix Metalloproteinases in Central Nervous System – Tuberculosis

et al. 2022

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Tuberculosis (TB) remains one of the leading infectious killers in the world, infecting approximately a quarter of the world’s population with the causative organism Mycobacterium tuberculosis (M. tb). Central nervous system tuberculosis (CNS-TB) is the most severe form of TB, with high mortality and residual neurological sequelae even with effective TB treatment. In CNS-TB, recruited neutrophils infiltrate into the brain to carry out its antimicrobial functions of degranulation, phagocytosis and NETosis. However, neutrophils also mediate inflammation, tissue destruction and immunopathology in the CNS. Neutrophils release key mediators including matrix metalloproteinase (MMPs) which degrade brain extracellular matrix (ECM), tumor necrosis factor (TNF)-α which may drive inflammation, reactive oxygen species (ROS) that drive cellular necrosis and neutrophil extracellular traps (NETs), interacting with platelets to form thrombi that may lead to ischemic stroke. Host-directed therapies (HDTs) targeting these key mediators are potentially exciting, but currently remain of unproven effectiveness. This article reviews the key role of neutrophils and neutrophil-derived mediators in driving CNS-TB immunopathology.

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“…Tuberculous meningitis (TBM) is thought of as one of the serious forms of TB disease. It was reported that 15%-30% of children with TBM died [2][3][4], and survivors are easy to have neurological disabilities [5,6]. Therefore, timely diagnosis and appropriate treatment are required to improve the current dilemma of the disease.…”

Section: Introductionmentioning

confidence: 99%

Normal cerebrospinal fluid protein and associated clinical characteristics in children with tuberculous meningitis

et al. 2021

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Background Although abnormal cerebrospinal fluid (CSF) protein can be used to predict the outcome of tuberculous meningitis (TBM) and diagnose TBM, normal CSF protein remains a concern in patients with TBM. This retrospective study aimed to assess the clinical characteristics associated with normal CSF protein, to resolve the dilemma of CSF protein in the management of childhood TBM. Methods Between January 2006 and December 2019, consecutive child patients (≤15 years old, a diagnosis of TBM, and tested for CSF protein) were included for analysis. CSF protein was tested on a chemistry analyzer using the pyrogallol red-molybdate method. Abnormal CSF protein was defined as >450 mg/L. Patient characteristics were collected from the electronic medical records. Then, characteristics associated with normal CSF protein were estimated in the study, using univariate and multivariate logistic regression analysis. Results A total of 125 children who met the criteria were enrolled during the study period. Twenty-nine patients had a normal CSF protein and 96 had an abnormal CSF protein. Multivariate analysis (Hosmer–Lemeshow goodness-of-fit test: χ 2 =2.486, df = 8, p = .962) revealed that vomiting (age- and sex-adjusted OR = 0.253, 95% CI: 0.091, 0.701; p = .008) and serum glucose (>5.08 mmol/L; age- and sex-adjusted OR = 0.119, 95% CI: 0.032, 0.443; p = .002) were associated with the normal CSF protein in childhood TBM. Conclusion In suspected childhood TBM, patients without vomiting or having low serum glucose are easy to present with normal CSF protein. Hence, when interpreting the level of CSF protein in children with such characteristics, a careful clinical assessment is required. KEY MESSAGES In suspected childhood tuberculous meningitis, patients without vomiting or having low serum glucose are easy to present with normal CSF protein. Hence, when interpreting the level of CSF protein in children with such characteristics, a careful clinical assessment is required.

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Early Mortality among Immunocompetent Patients of Tuberculous Meningitis: A Prospective Study

Cited by 9 publications

References 16 publications

Risk factors for poor outcome in childhood tuberculous meningitis

Risk factors for poor outcome in childhood tuberculous meningitis

Neutrophil-Mediated Immunopathology and Matrix Metalloproteinases in Central Nervous System – Tuberculosis

Normal cerebrospinal fluid protein and associated clinical characteristics in children with tuberculous meningitis

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