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Clinical presentations, diagnosis, mortality and prognostic markers of tuberculous meningitis in Vietnamese children: a prospective descriptive study.

Authors :
Bang ND
Caws M
Truc TT
Duong TN
Dung NH
Ha DT
Thwaites GE
Heemskerk D
Tarning J
Merson L
Van Toi P
Farrar JJ
Wolbers M
Pouplin T
Day JN
Source :
BMC infectious diseases [BMC Infect Dis] 2016 Oct 18; Vol. 16 (1), pp. 573. Date of Electronic Publication: 2016 Oct 18.
Publication Year :
2016

Abstract

Background: Tuberculous meningitis in adults is well characterized in Vietnam, but there are no data on the disease in children. We present a prospective descriptive study of Vietnamese children with TBM to define the presentation, course and characteristics associated with poor outcome.<br />Methods: A prospective descriptive study of 100 consecutively admitted children with TBM at Pham Ngoc Thach Hospital, Ho Chi Minh City. Cox and logistic regression were used to identify factors associated with risk of death and a combined endpoint of death or disability at treatment completion.<br />Results: The study enrolled from October 2009 to March 2011. Median age was 32.5 months; sex distribution was equal. Median duration of symptoms was 18.5 days and time from admission to treatment initiation was 11 days. Fifteen of 100 children died, 4 were lost to follow-up, and 27/81 (33 %) of survivors had intermediate or severe disability upon treatment completion. Microbiological confirmation of disease was made in 6 %. Baseline characteristics associated with death included convulsions (HR 3.46, 95CI 1.19-10.13, p = 0.02), decreased consciousness (HR 22.9, 95CI 3.01-174.3, p < 0.001), focal neurological deficits (HR 15.7, 95CI 1.67-2075, p = 0.01), Blantyre Coma Score (HR 3.75, 95CI 0.99-14.2, p < 0.001) and CSF protein, lactate and glucose levels. Neck stiffness, MRC grade (children aged >5 years) and hydrocephalus were also associated with the combined endpoint of death or disability.<br />Conclusions: Tuberculous meningitis in Vietnamese children has significant mortality and morbidity. There is significant delay in diagnosis; interventions that increase the speed of diagnosis and treatment initiation are likely to improve outcomes.

Details

Language :
English
ISSN :
1471-2334
Volume :
16
Issue :
1
Database :
MEDLINE
Journal :
BMC infectious diseases
Publication Type :
Academic Journal
Accession number :
27756256
Full Text :
https://doi.org/10.1186/s12879-016-1923-2