Tuberculous Meningitis in Children: Reducing the Burden of Death and Disability

Huynh, Julie; Abo, Yara-Natalie; Preez, Karen Du; Solomons, Regan; Dooley, Kelly E.; Seddon, James A

doi:10.3390/pathogens11010038

Cited by 25 publications

(27 citation statements)

References 91 publications

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“…In a recent review by Huynh et al, 11 research gaps in pediatric TBM treatment were identified. These included (1) unclear optimal antituberculous drug dosing, regimen and duration (short versus 12 months) to effectively treat pediatric TBM, (2) lack of pediatric pharmacokinetic studies, (3) whether the dosage of isoniazid should be adjusted in fast compared to slow acetylators and (4) which of ethambutol (first-line antituberculous drug), ethionamide or the fluoroquinolones (second-line antituberculous drugs) is the best option as the fourth drug in a drug-susceptible TBM regimen in addition to rifampin, isoniazid and pyrazinamide.…”

Section: Research Gapsmentioning

confidence: 99%

Update on the Treatment of Pediatric Tuberculous Meningitis

Solomons

Toorn

Cresswell

et al. 2022

Pediatric Infectious Disease Journal

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Section: Research Gapsmentioning

confidence: 99%

Update on the Treatment of Pediatric Tuberculous Meningitis

Solomons

Toorn

Cresswell

et al. 2022

Pediatric Infectious Disease Journal

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“…Central nervous system (CNS) tuberculosis mainly results from a primary MTB-infected pulmonary lesion that disseminates to the brain, spinal cord parenchyma, meninges, and surrounding tissues via the blood. CNS tuberculosis is relatively rare, accounting for 1-5% of all tuberculosis types, but it has a poor prognosis and fairly high fatality and disability rates (3)(4)(5)(6). Intraspinal tuberculosis is even rarer in clinical practice, mostly manifesting as tuberculous spinal meningitis and tuberculoma.…”

Section: Introductionmentioning

confidence: 99%

Magnetic Resonance Imaging Findings of Intraspinal Tuberculoma in Children

Zhou

Qin

et al. 2022

Front. Neurol.

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Background and PurposeIntraspinal tuberculoma is a rare disease in children, and its imaging findings have been described in only a few case reports. This study aimed to investigate the magnetic resonance imaging (MRI) features of pediatric intraspinal tuberculoma and to explore the possible pathogenesis of the disease.Materials and MethodsThe clinical and MRI data of 24 child patients with intraspinal tuberculoma (such as 6 cases of intramedullary tuberculoma, 8 cases of intradural extramedullary tuberculoma, and 10 cases of epidural tuberculoma) were retrospectively analyzed. All patients underwent plain and contrast-enhanced MR scans. The diagnosis was confirmed by surgical pathology or by antituberculous treatment and follow-up data.ResultsIntramedullary tuberculoma had a round shape, while intradural extramedullary tuberculoma and epidural tuberculoma presented long-fusiform or en plaque shapes. Regarding MRI signals, intramedullary tuberculoma and extramedullary tuberculoma were mainly isointense on T1-weighted imaging (T1WI) and hypointense or isointense on T2WI. Rim enhancement was observed in intramedullary tuberculoma, and marked homogeneous enhancement was dominant in extramedullary tuberculoma. Ten (10/24) tuberculomas occurred during antituberculous therapy, with intradural extramedullary tuberculoma accounting for 7 cases (7/8), which was significantly more frequent than intramedullary tuberculoma (1/6) or epidural tuberculoma (2/10).ConclusionMRI is important in the diagnosis of intraspinal tuberculoma, which is characterized by isointensity on T1WI, isointensity, or hypointensity on T2WI, and rim or obvious homogeneous enhancement. Some intraspinal tuberculomas, especially intradural extramedullary tuberculomas, might be associated with the “paradoxical response” mechanism during the tuberculosis treatment.

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“…Tuberculous meningitis (TBM) disproportionately affects young children. 1 It is extra-pulmonary tuberculosis characterized by sub-acute inflammation of the meninges that covers the brain and spinal cord. 2 , 3 TBM is the most severe form of tuberculosis and is associated with high mortality and morbidity rates in children.…”

Section: Introductionmentioning

confidence: 99%

“… 2 , 3 TBM is the most severe form of tuberculosis and is associated with high mortality and morbidity rates in children. 1 , 4 Even if diagnosed and treated, nearly 20% of children die, and of those surviving more than half will suffer from a neurological disability. 5 In children, it develops shortly after primary pulmonary tuberculosis due to the hematogenous dissemination of Mycobacterium tuberculosis (MTB) bacilli.…”

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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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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Tuberculous Meningitis in Children: Reducing the Burden of Death and Disability

Cited by 25 publications

References 91 publications

Update on the Treatment of Pediatric Tuberculous Meningitis

Update on the Treatment of Pediatric Tuberculous Meningitis

Magnetic Resonance Imaging Findings of Intraspinal Tuberculoma in Children

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

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