Risk Factors for Central Nervous System Tuberculosis

Abstract

OBJECTIVES: To describe the epidemiology and factors associated with pediatric central nervous system (CNS) tuberculosis (TB) in California from 1993 to 2011. METHODS:We analyzed California TB registry data for persons aged #18 years, comparing CNS TB cases versus non-CNS TB cases reported from 1993 to 2011. Factors associated with CNS TB and TB deaths were identified by using multivariate logistic regression.RESULTS: A total of 200 CNS TB cases were reported. Compared with non-CNS TB case patients, CNS TB case patients were more likely to be aged ,5 years (72.0% vs 43.6%; odds ratio [OR] CONCLUSIONS: Subsets of children are at increased risk for CNS TB in California and may benefit from additional prevention efforts. WHAT'S KNOWN ON THIS SUBJECT:Central nervous system (CNS) tuberculosis has high morbidity and mortality, and it frequently affects children aged ,5 years. WHAT THIS STUDY ADDS:In California, children who were US-born, Hispanic, and aged ,5 years were at increased risk of CNS tuberculosis. Children with CNS tuberculosis were more likely to die. Specific populations of US-born infants might benefit from additional prevention measures. Dr Duque-Silva was involved in research design, performed the data analysis and interpretation, and drafted and revised the manuscript; Ms Robsky was involved in research design and assisted with data analysis and interpretation; and Dr Flood assisted in research design and data interpretation, and reviewed and revised the manuscript. Dr Barry conceptualized the study; supervised the research design, data analysis, and interpretation; and critically reviewed and revised the manuscript. All authors approved the final manuscript as submitted. 2,3 It is most commonly diagnosed in children aged ,5 years and may affect the same groups at high risk for pediatric TB in the United States such as immigrants, racial and ethnic minorities, and children who traveled to a country with high prevalence of TB or who had contact with a household visitor from a high-prevalence country. [4][5][6] In children, CNS TB is often the result of recently acquired infection after close contact with an infectious TB case in an adult. Risk of dissemination to the CNS after TB exposure is influenced by age and immune status, 7 including BCG vaccination. In most countries outside the United States, BCG vaccination is recommended in early childhood to decrease the risk of disseminated forms of TB such as miliary and CNS TB in children. 8 BCG vaccination has not routinely been used in the United States. 9 California is the state that reports the most pediatric TB cases 10 and has the largest foreign-born population in the United States. 11 It is therefore an excellent population in which to examine the epidemiology of pediatric CNS TB. To inform ongoing CNS TB prevention activities, our goal was to describe the epidemiology of pediatric CNS TB in California from 1993 to 2011 and to identify factors associated with the development of pediatric CNS TB as well as factors associated with pedia...

A fatal case of tuberculous meningitis in a child with juvenile idiopathic arthritis: a diagnostic challenge

“…Mortality in patients with TBM is reported to be higher in those with culture-confirmed TB and has been shown to depend on the stage at which anti-TB treatment is initiated 1 . Early recognition is very important, and patients taking TNF antagonists should be followed up closely for the possible development of TB.…”

“…Tuberculous meningitis (TBM) accounts for about 1% of all cases of tuberculosis (TB) and 5% of all cases of extrapulmonary TB in immunocompetent individuals; patients with TBM have a high mortality rate, and residual neurologic sequelae can occur despite effective treatment 1,2 . Rheumatic disease itself is associated with a 2-4-fold increase in the risk of TB, even without the use of anti-tumor necrosis factor alpha (TNF-α) medications 3 .…”

“…Accordingly, progression of recently acquired TB infection or reactivation of previously acquired infection should be expected with the use of anti-TNF agents 4,5 . Early recognition is important because the clinical outcome depends upon the stage at which therapy is initiated 1 . A recently published review article reported 5 cases of TB occurring in pediatric patients while they were taking anti-TNF treatment 6 .…”

Interferon-γ Release Assay Performance for Tuberculosis in Childhood

“…Nevertheless, in severe forms of TB, TST sensitivity is limited; for example, only 60% of patients with proven TB meningitis receive TST positive results. 6 TST specificity is also suboptimal, because nontuberculous mycobacterial infection and BCG vaccination can cause false-positive TST results. 7 IGRAs have superior test specificity to TST, but data on their sensitivity in children with TB disease, especially those <5 years of age, remains limited.…”

Risk of Active Tuberculosis among Index Case of Householders—A Long‐Term Assessment after the Conventional Contacts Study

“…Further studies are needed to assess the effectiveness of long‐term surveillance programs on Mantoux‐negative or γ‐interferon‐negative children coming from CCSs. (Duque‐Silva, Robsky, Flood, & Barry, ; Lowenthal, Barry, & Flood, ).…”