Clinical Profile and Factors Associated with a Poor Outcome in Childhood Tuberculous Meningitis in a Developing Country: A 10 Year Case Review

Aketi, Loukia; Diayisu, J. Shiku; Tshibassu, Pierre M.; Nkwadiolandu, Adolphine; Kashongwe, Zacharie; Kasole, Toni Lubala; Mande, Dad; Kalambay, Patrick Kayembe

doi:10.9734/ijtdh/2017/31438

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“…Low levels of CSF glucose (66.6%) and elevated levels of protein (94.4%) comprise other characteristic abnormalities, which were evident in our series. This was similar to a study conducted by Aketi L et al [ 25 ] in which low levels of CSF glucose and high CSF protein was present in 91.6% of their cases. Normal CSF glucose levels were observed in 33.4% children, indicating that CSF glucose >40 mg/dL is not against the diagnosis of TBM.…”

Section: Discussionsupporting

confidence: 92%

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Clinical profile, yield of cartridge-based nucleic acid amplification test (GeneXpert), and outcome in children with tubercular meningitis

et al. 2020

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A BSTRACT Background: GeneXpert MTB/RIF is a test for early, rapid diagnosis of tubercular meningitis (TBM). Aim: The aim of this article was to study the clinical profile, radiological features, yield of GeneXpert, neurosurgical interventions, and outcome of TBM in children. Settings and Design: This was a retrospective and prospective observational study. Materials and Methods: Diagnosis was based on the uniform research definition criteria and was staged according to the British Medical Research Council. Mantoux test, analysis of cerebrospinal fluid (CSF), CSF GeneXpert, and radiological investigations were performed. Results: Of 36 patients, 50% were aged 1–5 years. Fever (100%), headache (82%), altered sensorium (80%), and vomiting (66%) were common features. Twelve (33%) had contact with active case of tuberculosis; 32 received Bacille Calmette Guarin vaccination. Neurological features included severe deterioration in sensorium (Glasgow Coma Scale < 8) (38%), mild and moderate deficit in sensorium (31%), hemiparesis (41%), and involvement of sixth (25%) and seventh (22%) cranial nerves. Cerebral vision impairment (25%), papilledema (25%), and dystonia (22%) were other findings. CSF GeneXpert was positive in 37% (12/33) patients. Hydrocephalus and basal exudates (75%) were noted on neuro-imaging. Surgical intervention was performed in children with hydrocephalus (13/27). Omayya reservoir was placed in seven children, of which five needed conversion to ventriculoperitoneal (VP) shunt; direct VP shunt was carried out in six (6/13). Good outcome was noted in 78% at discharge. Stage III TBM ( P = 0.0001), cerebral infarcts ( P = 0.0006), and motor deficits ( P = 0.03) were associated with poor outcome. Sequelae included learning difficulties with poor scholastic performance (31.5%). Conclusion: GeneXpert has high diagnostic specificity, but negative results do not rule out TBM. CSF GeneXpert provided quick results. Placement of Ommaya reservoir in TBM stage II and III with hydrocephalus was not successful. Hydrocephalus was managed conservatively with success (53%).

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Section: Discussionsupporting

confidence: 92%

“…Mortality in our study during the hospital stay was 9.4%. In contrast, Aketi L et al [ 25 ] noted lower cure rate (35.5%), sequelae (35.5%), but higher mortality rate (29.0%). Better outcomes may be reflective of better supportive care and early identification in our cohort.…”

Section: Discussionmentioning

confidence: 93%