Prognostic Value of Computed Tomography−Evident Cerebral Infarcts in Adult Patients with Tuberculous Meningitis and Hydrocephalus Treated with an External Ventricular Drain

Heemskerk

et al. 2016

CLINID

Section: Management and Monitoringmentioning

confidence: 99%

Standardized methods for enhanced quality and comparability of tuberculous meningitis studies

Heemskerk

et al. 2016

CLINID

“…The delayed resolution of cerebral exudate leads to ongoing inflammatory responses, even after initiating anti-TB medication, resulting in delayed infarcts [ 35 ]. Clemente Morgado et al, in a study of adult patients with TBM hydrocephalus, reported infarcts in 45.5% of patients, with 100% mortality in the HIV-infected group [ 36 ]. TB exudates can also infiltrate cranial nerves, resulting in deficits, as reported in 22.6% of children in our study [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

Factors associated with in-hospital mortality in HIV-infected children treated for tuberculous meningitis hydrocephalus

Enicker,

Aldous

2023

Childs Nerv Syst

Purpose The study aimed to investigate factors associated with in-hospital mortality in children diagnosed with tuberculous meningitis (TBM) hydrocephalus and HIV co-infection undergoing cerebrospinal fluid diversion procedures and their complications. Methods Data were collected retrospectively and prospectively between 2007 and 2022. Data collected included demographics, clinical characteristics, antiretroviral therapy (ART) status, biochemistry results, CD4 count, radiology findings, CSF diversion procedures (and complications), length of hospital stay (LOHS), and in-hospital mortality. Results Thirty-one children were included, with a mean age of 6.7 ± 5.3 years and 67.7% males. Median admission Glasgow Coma Scale (GCS) was 11 (IQR 9–15). Hypertonia (64.5%) and seizures (51.6%) were frequently observed clinical characteristics. Sixty-one percent of children were on ART. Cerebral infarcts and extra-meningeal TB were diagnosed in 64.5% and 19.3% of cases, respectively. The median CD4 count was 151 (IQR 70–732) cells/µL. Surgical procedures included ventriculoperitoneal shunt (VPS) in 26 cases and endoscopic third ventriculostomy (ETV) in five children. VPS complication rate was 27%. No complications were reported for ETV. Median LOHS was 7 days (IQR 4–21). Eleven children (35.5%) died during admission. Factors associated with mortality included GCS (p = 0.032), infarcts (p = 0.004), extra-meningeal TB (p = 0.003), VPS infection (p = 0.018), low CD4 count (p = 0.009), and hyponatremia (p = 0.002). No statistically significant factors were associated with VPS complications. Conclusion TBM hydrocephalus in HIV-infected children carries a high mortality. Clinicians in high-prevalence settings should have a high suspicion index and institute early treatment.

“…Scoping searches have been undertaken to identify candidate studies and inform keyword selection for electronic searching [ 15 , 45 – 47 ].…”

Section: Methodsmentioning

confidence: 99%

“…TBM, which is associated with thick basal exudate, can also result in non-communicating hydrocephalus [ 13 ]. TBM in the context of HIV infection appears to be associated with substantially increased morbidity and mortality compared with HIV non-infected patients [ 14 , 15 ]. This might arise because of synergistic effects of HIV and tuberculosis in the CNS causing depressed monocyte and microglial mediated immunity and dysregulated cytokine production [ 16 – 21 ].…”

Section: Introductionmentioning

confidence: 99%

Ventriculoperitoneal shunt insertion for hydrocephalus in human immunodeficiency virus-infected adults: a systematic review and meta-analysis protocol

et al. 2017

BackgroundHydrocephalus is a recognised complication of human immunodeficiency virus (HIV)-related opportunistic infections. Symptomatic raised cerebrospinal fluid pressure can be treated with ventriculoperitoneal shunt insertion (VPS). In HIV-infected patients however, there is a concern that VPS might be associated with unacceptably high rates of mortality. We aim to systematically review and appraise published literature to determine reported outcomes and identify predictors of outcome following VPS in relevant subgroups of HIV-infected adults.MethodsThe following electronic databases will be searched: The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (PubMed), EMBASE, CINAHL (EBSCOhost), LILACS (BIREME), Research Registry (www.researchregistry.com), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and OpenSIGLE database. Any randomised studies, cohort studies, case-control studies, interrupted time series or sequential case series reporting survival following VPS in HIV-infected individuals will be included. If high-quality homogenous studies exist, meta-analysis will be conducted to determine 1-, 6- and 12-month mortality with comparison made between underlying aetiologies of hydrocephalus.Discussion and conclusionThis study will generate a comprehensive review of VPS in HIV-infected patients for publication. The primary outcome of meta-analysis is 12-month survival. If only low-quality, heterogeneous studies are available, this study will demonstrate this deficiency and will be of value in justifying and aiding the design of future studies.Systematic review registrationPROSPERO CRD42016052239Electronic supplementary materialThe online version of this article (10.1186/s13643-017-0603-7) contains supplementary material, which is available to authorized users.