Epidemiological, clinical characteristics and drug resistance situation of culture-confirmed children TBM in southwest of China: a 6-year retrospective study

Abstract

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. Methods: We performed a retrospective study on children (< 14 years old) with cerebrospinal fluid (CSF) cultureconfirmed 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™ 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 (13.2%) were Mycobacterial culture positive. 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 belonged to 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 and more than 95% of patients did not receive BCG vaccination at birth. 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.

Treatment outcome and its associated factors among HIV-MTB co-infected patients in Sichuan, China: A retrospective study

“…Owing to its remote geographical position and the limitations of local medical services, Sichuan has a high incidence of TB (approximately 100 cases per 100,000 people), [9] with the second highest TB caseload among the provinces in China. [10] The HIV testing coverage and HIV-positive case detection rates in Sichuan were estimated to be approximately 76% and 0.9%, respectively, as revealed in the TB report of China 2019 from the Center of Disease Control and Prevention of China. Nonetheless, another investigation in Sichuan showed that HIV testing was not universally available for outpatient TB cases; only 29.5% (3227/10,946) of cases had HIV test results.…”

Linezolid-containing Regimen Lowers Mortality of Rifampicin/multidrug-resistant Tuberculous Meningitis in Shenzhen, China

“…As the most lethal tuberculosis type, there have been more and more reports of RR/MDR-TBM in China and abroad in recent years. Some small sample of studies have shown that RR/MDR-TBM accounts for 12%-39.29% of TBM patients in western China, isoniazid resistant TBM reached 64.29% [13,14], even in children (untreated previously for tuberculosis) MDR and XDR accounted for 7.2% [15]. Although the sample size of the above studies is small, it also indicates that RR/MDR-TBM was not rare in China.…”

Decreased mortality seen in rifampicin/multidrug-resistant tuberculous meningitis treated with linezolid in Shenzhen, China

“…Some small sample size studies had shown that RR/MDR-TBM accounted for 12%–39.29% of TBM patients in western China, and the ratio of isoniazid-resistant TBM even reached as high as 64.29% [ 14 , 15 ]. Even in children with first-time TB infection, MDR and XDR accounted for 7.2% [ 16 ]. Although the sample size of these studies was small, it still indicated that RR/MDR-TBM is not a rare disease in China.…”