NEUROLOGICAL COMPLICATIONS AND BACILLE CALMETTE-GUERIN VACCINATION STATUS OF CHILDREN WITH TUBERCULOUS MENINGITIS: A TERTIARY CARE HOSPITAL EXPERIENCE

Abstract

OBJECTIVE: To assess for the neurological complications and Bacille Calmette-Guerin (BCG) vaccination status of children with tuberculosis meningitis (TBM). METHODS: This retrospective study was conducted in Ayub Teaching Hospital, Abbottabad, Pakistan. Data of diagnosed case of TBM who received anti-tuberculous therapy from 2017 to 2020 was retrieved from records. Records of children, aged 6 months to 10 years of either gender were included and vaccination status was documented along with CT scan findings. Neurological complications in hospital and outcome were recorded as discharge, expiry and transfer to other hospital. RESULTS: Out of 40 patients, 17 (42.5%) were males and 23 (57.5%) females. Age ranged from 6 months to 8 years with mean age of 2.81±2.29 years. Weight ranged from 5 to 24 kg and mean weight was 10.36±4.96 kg. About 72.5% patients were <5 years of age. About 47.5% (n=19/40) patients were not vaccinated for BCG. Primary source of tuberculosis in close contacts was identified in 35% (n=14/40) patients. Common findings on CT scan were hydrocephalus (35.0%; n=14/40) & cerebral infarct (15.0%; n=6/40). The common complication observed were hydrocephalus (35%; n=14/40), acute stroke (20%; n=8/40), cranial nerve palsies (12.5%; n=5/40), seizure disorder (12.5%; n=5/40). Mortality rate was 2.5% (n=1/40). Only 35.7% (5/14) of patients with hydrocephalus and no patient with stroke or seizures were fully vaccinated. CONCLUSION: Hydrocephalus & stroke are the most common complication in children with TBM. Neurological complications were observed more commonly in children who were either not vaccinated or partially vaccinated for BCG.