Total delay in treatment among tuberculous meningitis patients in China: a retrospective cohort study

He, Yu; Han, Chao; Chang, Kai-Feng; Wang, Mao‐Shui; Huang, Tianren

doi:10.1186/s12879-017-2447-0

Cited by 32 publications

(28 citation statements)

References 18 publications

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“…In addition, children with TBM during hospitalization showed varying degrees of anti-tuberculosis drug-induced hyperuricemia (23.8%) and hepatotoxicity (14.3%). These frequent adverse events associated with TB treatment ratio were higher in the current study compared to previous ones [5,16]. This could be because the development of liver and kidney function in children is not perfect, and their ability to remove drugs is poor, which makes them more sensitive to drug reactions and more prone to adverse reactions compared to young adults.…”

Section: Discussioncontrasting

confidence: 58%

Epidemiological, Clinical characteristics and Drug resistance situation of Culture-confirmed Children TBM in Southwest of China: A 6-Year Retrospective Study

Wang

Li²,

Zhu³

et al. 2019

Preprint

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Background : Sichuan is a province located in southwestern China, which have a higher incidence of tuberculosis (TB).This study aimed to analyze the epidemiological and clinical characteristics, as well as drug resistance in culture-confirmed children with Tuberculosis meningitis (TBM) in Southwest of China. Materials and Methods: We performed a retrospective study on children (<14 years old) with cerebrospinal fluid (CSF) culture-confirmed TBM between January 2013 and December 2018 at Public Health Clinical Center of Chengdu (PHCCC). Mycobacterium tuberculosis (MTB) drug sensitivity testing (DST) was performed using the MicroDST TM method. The age, gender, family history of tuberculosis, status of Bacillus Calmette–Guérin (BCG) vaccination, residential areas information, clinical, laboratory, and radiological features were recorded. Data were analyzed using SPSS Statistics Client 25.0, and the change in drug resistance rate was examined using the Cruskal-Wallis test. Results: Among 319 patients clinically diagnosed with TBM, 42 cases were Mycobacterial culture-positive, with a positive rate of 13.2 per 100 patients. Their median age was nine years, and the distribution was equal among female and male patients. Among 42 patients who were enrolled in the study, 1/42 (2.38%) passed away. Children with TBM were concentrated in the minority areas of western Sichuan, where 34/42 (81.0%) patients with TBM were ethnic minorities, and only 2/42 (4.76%) received BCG vaccination in the past. Chest X-rays changes were observed in all patients. Fever and headache were the most common presenting symptom. Thirty-five (83.3%) patients suffered from neck stiffness, and 30/42 (71.4%) had high CSF pressure. DST results showed that the resistance rate was high; resistance to any anti-tuberculosis drug (ATD) was observed in 13 (31.0%) patient isolates, while multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) were found in 2 (4.8%) and 1 (2.4%) patients, respectively. Conclusions : TBM among children in Southwest China was mainly concentrated in the minority areas of western Sichuan. The most common symptoms were fever, headache, and neck stiffness and all patients had positive chest X-ray findings. In addition, high rates of drug resistance were found; and more than 95% of patients did not receive BCG vaccination at birth.ΦΦΦ

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Section: Discussioncontrasting

confidence: 58%

Epidemiological, Clinical characteristics and Drug resistance situation of Culture-confirmed Children TBM in Southwest of China: A 6-Year Retrospective Study

Wang

Li²,

Zhu³

et al. 2019

Preprint

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“…It may that smear positive PTB patients were easier to be diagnosed for bacteriological evidence, more likely to be infectious and NTP paid more attention to them than TB pleurisy patients. Previously treated patients had significantly higher treatment initiation delay which could be because of their previous bad experience of TB treatment, similar as reported elsewhere/before in India and China [13,32]. Patient registered in referral hospital had significant higher treatment initiation delay after diagnosis due to procedural and interest reasons [44].…”

Section: Predictors Of Health System Delaymentioning

confidence: 53%

“…The median total delay (22 days) and patient delay (16 days) were quite shorter compared to studies in other high TB burden countries [28,30]. Migrant TB patients received proper diagnosis and management within very short duration of having any symptom of TB and almost immediately after visiting a health facility in China [31] as other general populations [32]. We speculate that this was due to four important reasons.…”

Section: Short Patient and Health System Delaysmentioning

confidence: 81%

Patient and health system delays before registration among migrant patients with tuberculosis who were transferred out in China

Zhang

Shewade³

et al. 2018

BMC Health Serv Res

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BackgroundEarly diagnosis and treatment is vital for effective tuberculosis (TB) management especially among migrant populations who are a vulnerable group. We aimed to study factors associated with delay before registration at country level among registered migrant TB patients in China (2014–15) who were transferred out (during treatment) through web-based TB information management system (TBIMS).MethodsThis was a cross sectional study involving review of TBIMS data. Delays (in days) were classified as follows: patient delay (from symptom onset to first doctor visit), health system delay (from first doctor visit to treatment initiation, divided into health system diagnosis and treatment delay before and after date of diagnosis respectively), diagnosis delay (from symptom onset to diagnosis) and total delay (from symptom onset to treatment initiation). Linear regression was used to build a predictive model (forward stepwise) for the socio-demographic, clinical and health system related factors associated with delay: one model for each type of delay. Delays were log transformed and included in the model.ResultsThe median (IQR) patient delay, health system delay and total delay was 16 (6, 34), two (0, 6) and 22 (11, 41) days respectively. Factors associated with long patient, diagnosis and total delay were: female gender, age ≥ 65 years, sputum smear positive pulmonary TB and registration at referral hospital. Treatment initiation delay was significantly higher among those registered in referral hospitals, unemployed and previously treated. Among migrant patients having permanent residence out of province, health system diagnosis delay was significantly higher while treatment initiation delay after diagnosis was significantly lower when compared to patients having permanent residence within the prefecture.ConclusionAmong migrant population with TB, patient delay contributed to the total delay. The factors identified including the need for improved coordination between referral hospitals and national programme have to be addressed if China has to end TB.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3583-y) contains supplementary material, which is available to authorized users.

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“…Located in the southwest hinterland of the Chinese mainland, Sichuan province, the gateway to the southwest of China, is a big multi-ethnic family with the second largest Tibetan region in China. Although the Chinese government has strengthened TB control in minority areas in recent years and achieved some success, childhood TBM still remains a neglected field [3][4]. WHO and numerous studies have been reported that BCG vaccination can protect children from the severe types of TB such as TB meningitis and miliary TB [5][6].…”

Section: Discussionmentioning

confidence: 99%

Epidemiological, Clinical characteristics and Drug resistance situation of Culture-confirmed Children TBM in Southwest of China: A 6-Year Retrospective Study

Wang

Liao

Li³

et al. 2019

Preprint

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Background: There are little data on the disease in children. This study aimed to analyze the epidemiological, clinical characteristics and drug resistance situation of culture-confirmed children TBM in Southwest of China and hope this study will provide some recommendations to readers in clinical or related fields. Methods: We performed a retrospective study including children <14 years of age with cerebrospinal fluid (CSF) culture-confirmed TBM between January 2013 and December 2018 at Public Health Clinical Center of Chengdu (PHCCC). Nontuberculosis Mycobacteria (NTM) were excluded. Mycobacterium tuberculosis (MTB) drug sensitivity testing (DST) was performed using the MicroDSTTM method. The age, gender, family history of tuberculosis, status of Bacillus Calmette-Guérin (BCG) vaccination, residential areas information, clinical, laboratory and radiological features were recorded. Data were analyzed using SPSS Statistics Client 19.0, and the change in drug resistance rate was analyzed using the chi-square ( 2) test. Results: From 3467 probable TBM patients recruited, 295 cases were Mycobacterial culture-positive, the positive rate of 8.5 per 100 patients, included 253 adults and 42 children. We included all the 42 children <14 years of age for this study, the median age was 9 years, sex distribution was equal, of which 1/42 (2.38%) died. The geographical distribution of children's TBM in southwest of China is mainly concentrated in the minority areas of western Sichuan. Thirty-four (81.0%) children TBM patients is the population ofChina's ethnic minorities, only 2/42 (4.76%) had BCG vaccination histories. All the 42 patients had varying degrees of Chest X-rays changes and 18/42(42.9%) merger of extracranial TB. Fever and headache are the most common presenting symptom. Thirty-five (83.3%) with neck stiffness and 30/42(71.4%) with high CSF pressure. DST results showed that the resistance rate was high, to any anti-tuberculosis drug (ATD) resistance was 18 (42.9%), to multidrug-resistant tuberculosis (MDR-TB) and pre-XDR rate were 1 (2.4%) respectively. Conclusions: TBM in Children in Southwest China were mainly concentrated in the minority areas of western Sichuan, presents with nonspecific clinical features and all with positive chest X-ray findings. High rates of drug resistance were founded. More than 95% of patients were lack of BCG vaccination at birth.

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Total delay in treatment among tuberculous meningitis patients in China: a retrospective cohort study

Cited by 32 publications

References 18 publications

Epidemiological, Clinical characteristics and Drug resistance situation of Culture-confirmed Children TBM in Southwest of China: A 6-Year Retrospective Study

Epidemiological, Clinical characteristics and Drug resistance situation of Culture-confirmed Children TBM in Southwest of China: A 6-Year Retrospective Study

Patient and health system delays before registration among migrant patients with tuberculosis who were transferred out in China

Epidemiological, Clinical characteristics and Drug resistance situation of Culture-confirmed Children TBM in Southwest of China: A 6-Year Retrospective Study

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