Document Detail

Twenty years of pediatric tuberculous meningitis: a retrospective cohort study in the western cape of South Africa.
MedLine Citation:
PMID:  19367678     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Tuberculous meningitis is the most severe extrapulmonary complication of tuberculosis, with high morbidity and mortality rates. The objective of this study was to assess the relationship between presenting clinical characteristics and outcome of pediatric tuberculous meningitis. PATIENTS AND METHODS: We present a retrospective cohort study of all of the children diagnosed with tuberculous meningitis in a large university hospital in South Africa between January 1985 and April 2005. We compared demographic, clinical, and diagnostic characteristics with clinical outcome after 6 months of treatment. RESULTS: We included 554 patients. Common characteristics on admission were young age (82%; <5 years), stage II or III tuberculous meningitis (97%), nonspecific symptoms existing for >1 week (58%), poor weight gain or weight loss (91%), loss of consciousness (96%), motor deficit (63%), meningeal irritation (98%), raised intracranial pressure (23%), brainstem dysfunction (39%), and cranial nerve palsies(27%). Common features of tuberculous meningitis on computed tomography scan of the brain were hydrocephalus (82%), periventricular lucency (57%), infarctions(32%), and basal meningeal enhancement (75%). Clinical outcome after 6 months was as follows: normal (16%), mild sequelae (52%), severe sequelae (19%), and death (13%). All of the patients diagnosed with stage I tuberculous meningitis had normal outcome. Factors associated with poor outcome in univariate analyses were as follows: African ethnicity, young age, HIV coinfection, stage III tuberculous meningitis, absence of headache and vomiting, convulsions, decreased level of consciousness,motor deficits, cranial nerve palsies, raised intracranial pressure, brain stem dysfunction and radiographic evidence of hydrocephalus, periventricular lucency, and infarction. Ethnicity, stage of disease, headache, convulsions, motor function, brainstem dysfunction, and cerebral infarctions were independently associated with poor outcome in multivariate logistic regression analysis. CONCLUSIONS: Tuberculous meningitis starts with nonspecific symptoms and is often only diagnosed when brain damage has already occurred. Earlier diagnosis will improve outcome significantly. We were able to identify presenting variables independently associated with poor clinical outcome.
Gijs T J van Well; Berbe F Paes; Caroline B Terwee; Priscilla Springer; John J Roord; Peter R Donald; A Marceline van Furth; Johan F Schoeman
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Pediatrics     Volume:  123     ISSN:  1098-4275     ISO Abbreviation:  Pediatrics     Publication Date:  2009  
Date Detail:
Created Date:  2009-04-14     Completed Date:  2009-04-15     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376422     Medline TA:  Pediatrics     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e1-8     Citation Subset:  AIM; IM    
Departments of Pediatrics and Infectious Diseases, VU University Medical Center, Amsterdam, Netherlands; Department of Pediatrics, Maastricht University Medical Center, Maastricht, Netherlands.
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MeSH Terms
Age Factors
Child, Preschool
Cohort Studies
HIV Infections / complications
Hospitals, University
Hydrocephalus / etiology,  therapy
Infant, Newborn
Retrospective Studies
South Africa
Treatment Outcome
Tuberculosis, Meningeal / complications,  diagnosis*,  drug therapy,  ethnology,  physiopathology*

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