Childhood Tubercular Meningitis: An Institutional Experience and Analysis of Predictors of Outcome

Ramzan, Altaf; Nayil, Khursheed; Asimi, Rouf; Wani, Abrar Ahad; Makhdoomi, Rumana; Jain, Ashish

doi:10.1016/j.pediatrneurol.2012.09.004

Cited by 34 publications

(31 citation statements)

References 18 publications

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“…Diagnosis is challenging due to its nonspecific clinical presentation [4]. Children with headache, fever, vomiting and altered sensorium should be evaluated quickly for tubercular meningitis [11]. Consistent with the literature, our patient had only symptoms of fever, reduced consciousness and vomiting.…”

Section: Discussionsupporting

confidence: 67%

“…At the same time, MRI is important for the identification and monitoring of tuberculous meningitis related cranial neuropathies [14]. Hydrocephalus is the most common complication of tuberculous meningitis occurring in 50-80% of pediatric patients at admission [15] as a result of a basal adhesive meningeal reaction and the obliteration of arachnoid villi [11]. Hydrocephalus, stroke, and tuberculoma formation are the major complications of tuberculous meningitis which develop within the first 3 months of treatment and can be mortal if not detected and treated rapidly [9].…”

Section: Discussionmentioning

confidence: 99%

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Tuberculous Meningitis in The Differential Diagnosis of Cns Infection and the Urgency of Antituberculosis Treatment

Şahin¹,

Yazıcı²,

Ayar³

et al. 2015

J Eme Med Int Care

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Tuberculosis is a chronic necrotizing granulomatous disease caused by Mycobacterium tuberculosis, causes morbidity and mortality worldwide, and affects children as in all age groups. Tuberculous meningitis (TM) is the most severe form of the disease. The pathogenesis of TM is poorly understood and the best management has not been established. We report 17-years old female patient, who was referred from Somalia with a suspected intracranial mass lesion accompanied by poor general condition, reduced consciousness, hypertension and bradycardia, diagnosed as TM after brain biopsy with result of positive PCR and culture for M. tuberculosis. But the patient died after diagnosis of tuberculous meningitis in the last phase. The aim of this case report is to remind that TM must be considered in the differential diagnosis of intracranial infection in patients from endemic areas and the treatment should be initiated rapidly to prevent delayed diagnosis and lethal complications.

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Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Tuberculous Meningitis in The Differential Diagnosis of Cns Infection and the Urgency of Antituberculosis Treatment

Şahin¹,

Yazıcı²,

Ayar³

et al. 2015

J Eme Med Int Care

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“…7,8 Our study showed a higher mortality probably because of the fact that most of our patients were already in stage III at presentation. It could also be due to the fact that we could not follow up a significant proportion of children.…”

mentioning

confidence: 58%

“…Our figures might have been different if we could have followed up more children. We had only 2.4% with severe disability as compared to 28% in the JIPMER study 8 . It is also possible that only the children who were better had come for review.…”

mentioning

confidence: 95%

“…4,6 There have been few studies looking at the clinico-patho-radiological spectrum of TB meningitis in children from India. 7,8 In these backgrounds a study was conducted to look at the clinical outcome of children presented with TB Meningitis in a tertiary care centre in southern India by following them up and assess their present state in terms of neurological deficits, hearing and visual deficits, learning difficulties and day to day performances.…”

Section: Introductionmentioning

confidence: 99%

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

Mohan

Rakesh

Moses

et al. 2016

Int J Community Med Public Health

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Background: TB Meningitis is one of the most serious forms of Tuberculosis. Objective of the current study was to assess the clinical outcome of children presented with TB Meningitis in a tertiary care centre in southern India by following them up and assess their present state in terms of neurological deficits, hearing and visual deficits, learning difficulties and day to day performances.Methods: Children between 0 - 15 years diagnosed to have TB meningitis in a 2700 bedded hospital in Tamilnadu, India, during the time period 1999-2003 were identified through medical records. These children were called back after 2 to 7 years and health status in terms of neurological deficits, learning deficits, persisting seizures and day to day performance, hearing, ophthalmologic assessment and Intelligence quotient assessment were assessed.Results: Nearly one third of the children with TB meningitis showed complete recovery. One third died and another one third had some disability. Major problem (46%) encountered in TB meningitis survivors was behavioural problems; the commonest being hyperactivity. Ten out of 27 children had poor scholastic performances, six had neurological deficits and four had seizure disorders. Of 17 children assessed, two had hearing impairment and five had visual impairment. All children with hydrocephalus and were shunted within five days had fully recovered. Of the children shunted later, 9 children (60%) had some sequelae.Conclusions: Childhood TB meningitis has very poor outcomes. Poor prognosis and difficult early diagnosis emphasise the importance of preventive therapy for child contacts of patients with tuberculosis.

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Six months therapy for tuberculous meningitis

Jullien¹,

Ryan

Modi

et al. 2016

Cochrane Database of Systematic Reviews

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BackgroundTuberculous meningitis (TBM) is the main form of tuberculosis that affects the central nervous system and is associated with high rates of death and disability. Most international guidelines recommend longer antituberculous treatment (ATT) regimens for TBM than for pulmonary tuberculosis disease to prevent relapse. However, longer regimens are associated with poor adherence, which could contribute to increased relapse, development of drug resistance, and increased costs to patients and healthcare systems.ObjectivesTo compare the effects of short-course (six months) regimens versus prolonged-course regimens for people with tuberculous meningitis (TBM).Search methodsWe searched the following databases up to 31 March 2016: the Cochrane Infectious Diseases Group Specialized Register; the Cochrane Central Register of Controlled Trials (CENTRAL), published in the Cochrane Library; MEDLINE; EMBASE; LILACS; INDMED; and the South Asian Database of Controlled Clinical Trials. We searched the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov for ongoing trials. We also checked article reference lists and contacted researchers in the field.Selection criteriaWe included randomized controlled trials (RCTs) and prospective cohort studies of adults and children with TBM treated with antituberculous regimens that included rifampicin for six months or longer than six months. The primary outcome was relapse, and included studies required a minimum of six months follow-up after completion of treatment.Data collection and analysisTwo review authors (SJ and HR) independently assessed the literature search results for eligibility, and performed data extraction and 'Risk of bias' assessments of the included studies. We contacted study authors for additional information when necessary. Most data came from single arm cohort studies without a direct comparison so we pooled the findings for each group of cohorts and presented them separately using a complete-case analysis. We assessed the quality of the evidence narratively, as using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was inappropriate with no direct comparisons between short- and prolonged-course regimens.Main resultsFour RCTs and 12 prospective cohort studies met our inclusion criteria, and included a total of 1881 participants with TBM. None of the included RCTs directly compared six months versus longer regimens, so we analysed all data as individual cohorts to obtain relapse rates in each set of cohorts.We included seven cohorts of participants treated for six months, with a total of 458 participants. Three studies were conducted in Thailand, two in South Africa, and one each in Ecuador and Papua New Guinea between the 1980s and 2009. We included 12 cohorts of participants treated for longer than six months (ranging from eight to 16 months), with a total of 1423 participants. Four studies were conducted in India, three in Thailand and one each in China, South Africa,...

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Childhood Tubercular Meningitis: An Institutional Experience and Analysis of Predictors of Outcome

Cited by 34 publications

References 18 publications

Tuberculous Meningitis in The Differential Diagnosis of Cns Infection and the Urgency of Antituberculosis Treatment

Tuberculous Meningitis in The Differential Diagnosis of Cns Infection and the Urgency of Antituberculosis Treatment

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

Six months therapy for tuberculous meningitis

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