Abstract
BackgroundTuberculous 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.MethodsA 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.ResultsThe 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.ConclusionsTuberculous 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.
Highlights
Tuberculous meningitis in adults is well characterized in Vietnam, but there are no data on the disease in children
Tuberculous meningitis in adults is well characterized in Vietnam, and these data have been key in developing treatment guidelines, but there are no data on the disease in children [11, 15,16,17]
Study aim This study aimed to describe the current practice in the management of Vietnamese children with Tuberculous meningitis (TBM), the presenting clinical features and predictors of poor outcome, in order to define the challenges in management and prioritise research
Summary
Tuberculous meningitis in adults is well characterized in Vietnam, but there are no data on the disease in children. 5 % of disease occurs in HIV coinfected children, this is higher in sub-Saharan Africa [3]. Despite this high burden, in TB as in many other diseases, children are a neglected group - the vast majority of data used to guide management are derived from adult patients. Children are more likely than adults to develop disseminated TB and TB meningitis following infection [5]. This risk is greatest for infants and children under 2 years of age, probably due to the immaturity of the immune system [6]. It is striking that there has never been a randomized controlled trial of anti-tuberculosis drugs in children with TBM [13]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
