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

Fatema, Kanij; Rahman, MM; Akhter, Shaheen; Akter, Nazma; Paul, Bikush Chandra; Begum, Suraiya; Begum, Fatima

doi:10.1177/0883073819884169

Cited by 7 publications

(11 citation statements)

References 25 publications

(28 reference statements)

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“…Nearly, one-third (28.1%) were discharged with neurological sequelae and the remains (38.0%) were discharged with a normal outcomes. This is comparable to studies conducted in Indonesia (26.5%), 3 Bangladesh (33%), 6 and India 18 However, it is higher than that reported in many studies such as Uganda (8%), 10 Ethiopia (14.3%), 21 South Africa (13%), (11.1%), 4 , 34 and supported by systematic review and meta-analysis (19.3%). 5 This may be due to children presenting to the hospital at an advanced stage of the disease and complications of TBM such as seizures, raised intracranial pressure, brain herniation, and hydrocephalus.…”

Section: Discussionsupporting

confidence: 72%

“…The most common neurological sequelae were blindness, hearing loss, motor deficits, cranial nerve palsy, hydrocephalus, and mental retardation. 3 , 6 , 7 According to a hospital-based study in South Africa, TBM affects more than 10% of tuberculosis cases and about 8% and 50% had treatment outcomes of death and neurological disability among children, respectively. 8 , 10 The disease burden increases up to one-fifth of the cases with a mortality rate of 15% and neurological sequelae of 21%.…”

Section: Introductionmentioning

confidence: 99%

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Tuberculous Meningitis in Children: Treatment Outcomes at Discharge and Its Associated Factors in Eastern Ethiopia: A Five Years Retrospective Study

Abdella¹,

Deginet²,

Weldegebreal³

et al. 2022

IDR

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Background Tuberculous meningitis is a serious public health problem, particularly in low-income countries. It is associated with high rates of mortality and morbidity. The outcome of tuberculous meningitis in children is not well documented in Ethiopia, particularly in eastern Ethiopia. This study aimed to determine the treatment outcomes of tuberculous meningitis at discharge and its associated factors in eastern Ethiopia. Methods An institutional-based retrospective cross-sectional study was conducted on 121 children who were admitted and treated for tuberculous meningitis between January 2017 and December 2021. Data were collected using a pretested checklist, coded and entered into EpiData version 3.1, and analyzed using Statistical Package for the Social Sciences (SPSS) version 25. Factors associated with treatment outcomes were identified using multivariable logistic regression analyses. The association was described using the adjusted odds ratio (AOR) at a 95% confidence interval (CI). Finally, statistical significance was set at a p-value <0.05. Results Of the 121 medical records of children, 33.9% (95% CI:25–42%) died. Among the survivors, 28.1% were discharged with neurological sequelae and the remains (38.0%) were discharged with normal outcomes. In multivariable analyses, nutritional status (AOR=2.87; 95% CI:1.04–7.94), duration of illness (AOR = 0.33; 95% CI: 0.15–0.86), hydrocephalus (AOR=3.78; 95% CI:1.08–13.34), and stage-III Tuberculous Meningitis (AOR = 5.29; 95% CI:1.88–14.84) were identified as significantly associated factors with poor clinical outcomes. Conclusion The treatment outcomes for tuberculous meningitis in children are unfavorable. Two-thirds of children had poor treatment outcomes. Malnutrition, disease stage, hydrocephalus, and illness duration were associated with poor treatment outcomes at discharge. Health workers in primary health care should be aware of the importance of early screening, diagnosis, and treatment to improve clinical outcomes and reduce associated mortality and disability. In practice, more attention should be paid to children with malnutrition and hydrocephalus.

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Section: Discussionsupporting

confidence: 72%

Section: Introductionmentioning

confidence: 99%

Tuberculous Meningitis in Children: Treatment Outcomes at Discharge and Its Associated Factors in Eastern Ethiopia: A Five Years Retrospective Study

Abdella¹,

Deginet²,

Weldegebreal³

et al. 2022

IDR

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“…2,3,17,21,23,26,30 This higher incidence of tuberculomas could be due to better imaging techniques or a changing pattern of tubercular meningitis. Fatima et al 27 has also showed tuberculoma in 50% cases. In the present study, tubercular meningitis associated tuberculomas were either solitary or multiple, involving the posterior parts of the brain, basal ganglia, and thalamus.…”

Section: Discussionmentioning

confidence: 90%

“…2,14,17,20,24 -26 Over the years, the percentage of patients presenting with altered sensorium has decreased markedly; an explanation could be increased awareness about the disease leading to an early diagnosis or fewer patients progressing to its severe form because of partial treatment with antibiotics with antitubercular effect prior to presentation. 19,21,27 Loss of appetite and weight loss, which are classical features of tuberculosis, were seen in very few patients. Isolated tuberculomas patients had seizures as the most common presenting complaint; other studies have also reported headache, vomiting, and fever with varying frequency.…”

Section: Discussionmentioning

confidence: 99%

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Changing Clinicoradiologic Spectrum of Intracranial Neurotuberculosis in Children: A Cross-sectional Study

et al. 2020

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Background: Neurotuberculosis is among the most severe type of tuberculosis with high mortality and morbidity in all age groups. Various sociodemographic and disease-/treatment-related factors have emerged over the years that can affect clinical and radiologic features of neurotuberculosis. Objective: To investigate various clinical and neuroradiologic presentations of neurotuberculosis. Methodology: This cross-sectional study was done in a tertiary care center of northern India. The patients between the ages of 3 months and 18 years with newly diagnosed neurotuberculosis were enrolled after taking informed consent. Results: A total of 78 patients (37% males) were enrolled. Fifty-six patients (72%) had tubercular meningitis (TBM) and 22 (28%) isolated tuberculomas. Very high percentage of patients in both the groups was BCG vaccinated. In the tubercular meningitis group, fever (68%), headache (59%), and vomiting (54%) were the most common complaints whereas in the tuberculoma group, seizures (95.5%) were the main complaint and systemic symptoms were rare. In tubercular meningitis patients, cerebrospinal fluid–based studies showed cartridge-based nucleic acid amplification test (Xpert MTB/RIF) positivity for Mycobacterium tuberculosis in 17.6% cases, whereas on gastric aspirate and sputum examination, acid-fast bacilli were seen in 30.7% and cartridge-based nucleic acid amplification test was positive in 19% patients. On neuroimaging, hydrocephalus was seen in 44.6% of tubercular meningitis patients, infarcts in 32%, and basal exudates in 12% patients only; coexistent tuberculomas were seen in 53%. Conclusion: Compared with the available literature, the present study showed a smaller percentage of children <5 years of age, stage III tubercular meningitis cases, and typical neuroradiologic findings like hydrocephalus and basal exudates and more tuberculomas associated with tubercular meningitis.

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Clinical and diagnostic features of central nervous system tuberculosis in Indian children – a descriptive study

Daniel,

Selladurai,

Balaji

et al. 2024

Therapeutic Advances in Infection

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Background: Children with tuberculous meningitis (TBM) present with diagnostic challenges as they often have atypical clinical features. Objective: To describe the baseline characteristic features of children diagnosed with central nervous system (CNS) TB (TBM and tuberculoma). Design: Retrospective descriptive study. Methods: Children less than 12 years presenting with neurological signs and symptoms were assessed for a therapeutic TBM trial eligibility. The results of their clinical, laboratory, neuroimaging, cerebrospinal fluid evaluations were analysed for TBM diagnosis. Results: Of 600 children evaluated, 61(10%) had CNS tuberculosis; TBM 47, tuberculoma 14. 20(33%) had definite TBM. Mean age of children with TBM was 5 ± 3.4 years. Of 47, 13(28%), 21(45%) and 13(28%) had grade I, II, and III disease respectively. Abnormalities suggestive of TBM in MRI and computed tomography brain were observed in 76% (26/34) and 77% (24/31) respectively. Abnormal cerebrospinal fluid white blood cell count, protein and glucose were observed in 56% (24/43), 49% (22/45), 47% (21/45) respectively. Among 41 patients with TBM followed up until discharge, five died. Conclusion: Younger children with TBM have severe forms. Confirmatory results may not be available in all. A holistic approach to care including addressing complications of hydrocephalus and strokes is needed.

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

Cited by 7 publications

References 25 publications

Tuberculous Meningitis in Children: Treatment Outcomes at Discharge and Its Associated Factors in Eastern Ethiopia: A Five Years Retrospective Study

Tuberculous Meningitis in Children: Treatment Outcomes at Discharge and Its Associated Factors in Eastern Ethiopia: A Five Years Retrospective Study

Changing Clinicoradiologic Spectrum of Intracranial Neurotuberculosis in Children: A Cross-sectional Study

Clinical and diagnostic features of central nervous system tuberculosis in Indian children – a descriptive study

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