Outcome of children with tuberculous meningitis: a prospective study from a tertiary care centre in Southern India

Mohan, Jesinth; Rakesh, P S; Moses, Prabhakar D.; Varkki, Sneha

doi:10.18203/2394-6040.ijcmph20164742

Cited by 8 publications

(7 citation statements)

References 5 publications

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“…van Well et al 32 reported that 16 per cent of the children were normal, 52 per cent had mild sequelae, 19 per cent had severe sequelae and 13 per cent died when followed up after six months. In a study from southern India, children treated for TBM were reviewed after 2 to 7 yr, 46 per cent had behavioural problems, 46 per cent had poor schooling performance, 22 per cent had neurological deficit and 15 per cent had seizure disorder95. Miftode et al 33 reported that children had higher frequency of neurological deficits; however, mortality rates were similar to adults.…”

Section: Discussionmentioning

confidence: 99%

Tuberculous meningitis in children

Daniel

Gathungu

Natrajan

2019

Indian Journal of Medical Research

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Although the occurrence of tuberculous meningitis (TBM) in children is relatively rare, but it is associated with higher rates of mortality and severe morbidity. The peak incidence of TBM occurs in younger children who are less than five years of age, and most children present with late-stage disease. Confirmation of diagnosis is often difficult, and other infectious causes such as bacterial, viral and fungal causes must be ruled out. Bacteriological confirmation of diagnosis is ideal but is often difficult because of its paucibacillary nature as well as decreased sensitivity and specificity of diagnostic tests. Early diagnosis and management of the disease, though difficult, is essential to avoid death or neurologic disability. Hence, a high degree of suspicion and a combined battery of tests including clinical, bacteriological and neuroimaging help in diagnosis of TBM. Children diagnosed with TBM should be managed with antituberculosis therapy (ATT) and steroids. There are studies reporting low concentrations of ATT, especially of rifampicin and ethambutol in cerebrospinal fluid (CSF), and very young children are at higher risk of low ATT drug concentrations. Further studies are needed to identify appropriate regimens with adequate dosing of ATT for the management of paediatric TBM to improve treatment outcomes. This review describes the clinical presentation, investigations, management and outcome of TBM in children and also discusses various studies conducted among children with TBM.

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Section: Discussionmentioning

confidence: 99%

Tuberculous meningitis in children

Daniel

Gathungu

Natrajan

2019

Indian Journal of Medical Research

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“…This was consistent with other studies where poor outcome was associated with hydrocephalus, tubercle, and cerebral infarct. 33…”

Section: Discussionmentioning

confidence: 99%

Clinicoradiologic Profile and Outcome of Children With Tubercular Meningitis in a Tertiary Care Hospital in Bangladesh

et al. 2019

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Background: Children are most vulnerable to tubercular meningitis. Neuroimaging is an important initial investigation in tubercular meningitis. Objective: This study was done to describe the clinical profile, neuroimaging changes, and clinical outcome in children with tubercular meningitis. Methodology: This was an observational cohort study on children with tubercular meningitis, between January 2012 and June 2018. Tubercular meningitis was diagnosed on the basis of clinical criteria, cerebrospinal fluid analysis, neuroimaging, and response to antitubercular drug treatment. Preferably magnetic resonance imaging (MRI) with contrast was done. Result: Out of 79 pediatric patients, 17 patients were lost during follow-up; thus, a total of 62 patients were studied. Mean age at presentation was 7.040 (±3.99 SD) year, 51.6% children were male. Rural children were more affected. Twenty eight (45.2 patients had contact with a person with tuberculosis. Only 3 (4.8%) patients presented within 10 days of duration of illness. Most of the cases (67.7%) were in stage 2 at the time of diagnosis. The most common clinical feature was fever, seizure, and signs of meningeal irritation (all present in 12.9%). In neuroimaging most common findings were tuberculoma (50%), hydrocephalus (54.8%), and basal meningeal enhancement (33.8%). Regarding outcome, 6 (9.67%) patients expired and 47 (75%) patients had sequelae. The most common complications were hydrocephalus (30.64%) and intellectual disability (12.9 ). Hydrocephalus was the most common neuroimaging finding among the patients who expired (33%). Conclusion: Hydrocephalus is the most common neuroimaging finding. Normal neuroimaging is associated with good outcome whereas all the patients who died had abnormal neuroimaging.

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“…Many studies recognise that tuberculous meningitis, a severe complication associated with tuberculosis, can have implications for cognitive development in children. 34–36 Data from the present study did not specify the severity of tuberculosis infections in study members, thus limiting comparability with other studies. The studies on the effects of tuberculous meningitis on cognition did not stratify results for each sex, 34–36 although in one study mortality in females was higher.…”

Section: Discussionmentioning

confidence: 82%

“…34–36 Data from the present study did not specify the severity of tuberculosis infections in study members, thus limiting comparability with other studies. The studies on the effects of tuberculous meningitis on cognition did not stratify results for each sex, 34–36 although in one study mortality in females was higher. This indicates a need for more research on the effects of tuberculosis between sexes.…”

Section: Discussionmentioning

confidence: 82%

Associations between early infections and childhood cognition in the Newcastle Thousand Families Study birth cohort

Pennock,

Slack,

Grebby

et al. 2023

J Dev Orig Health Dis

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Childhood infections have been shown to stunt growth, contribute to malnutrition and reduce cognition in early adulthood. This study aimed to assess relationships between early life infections and childhood cognition at age 11 years in the Newcastle Thousand Families Study (NTFS). The analysis included 741 members from the NTFS who had complete data for infections between birth and 5 years, and the 11-plus examinations. School records from the 11-plus examinations showed cognitive (IQ), English (EQ) and arithmetic (AQ) abilities. Housing conditions, overcrowding, birth order and social class were recorded at birth. Helicobacter pylori seropositivity was measured at age 49–51 years. Multivariable linear regression was used to examine relationships between infections and cognition. The total number of infections in the first 5 years of life was not significantly associated with IQ, EQ or AQ, nor were there significant relationships between cognitive outcomes and most infections. Tonsillitis did display a positive, significant association with IQ after adjustment for confounders (b = 6.43, 95% CI 0.92, 11.94, p = 0.022). Lower respiratory tract infections (LRTIs) showed significant negative relationships with all cognitive outcomes. H. pylori seropositivity at age 50 exhibited negative, significant relationships with EQ (p = 0.014) and AQ (p = 0.024) after adjustment for confounders. Although no significant relationship between overall infections and cognition were found, there were indications that LRTIs and gastrointestinal system infections may limit cognitive development. Given these infections remain prevalent, further research regarding severity and recurrence of infections and how they affect childhood cognition is needed.

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Outcome of children with tuberculous meningitis: a prospective study from a tertiary care centre in Southern India

Cited by 8 publications

References 5 publications

Tuberculous meningitis in children

Tuberculous meningitis in children

Clinicoradiologic Profile and Outcome of Children With Tubercular Meningitis in a Tertiary Care Hospital in Bangladesh

Associations between early infections and childhood cognition in the Newcastle Thousand Families Study birth cohort

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