Presentation and outcome of tuberculous meningitis among children: experiences from a tertiary children's hospital.

Nicolette Nabukeera-Barungi,Muloiwa Rudzani,James Nuttall,Jo Wilmshurst

doi:10.4314/ahs.v14i1.22

Nicolette Nabukeera-Barungi, Muloiwa Rudzani + Show 2 more

Open Access

https://doi.org/10.4314/ahs.v14i1.22

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Journal: African health sciences	Publication Date: Mar 11, 2014
Citations: 19	License type: cc-by

Affiliation: Makerere University

Abstract

Diagnosis of tuberculous meningitis (TBM) is complicated and outcome is poor especially in resource limited settings. Early diagnosis and prompt treatment are vital in effective treatment. We set out to describe experiences in the management and immediate outcome of TBM a tertiary-level children's hospital in a high HIV and tuberculosis co-infection setting. This retrospective study included children who were diagnosed with TBM in the year 2009. A pre-coded questionnaire was used to extract data on presentation, diagnostics, treatment and outcome at the time of hospital discharge. Data was analyzed using STATA statistical package (StataCorp, Version 11). Of the 40 children diagnosed with TBM, 6 (15%) had definitive TBM, 17 (42.5%) had probable TBM and 17 (42.5%) had possible TBM. The cerebrospinal fluid (CSF) chemistry and cells were abnormal in 39/40 (98%). Mantoux test was reactive in 16/29 (55%) and 17/30 (57%) had Chest X-rays suggestive of tuberculosis. Only 3/21 (14%) had positive sputum tuberculosis culture and 89% (32/36) had neuro-imaging abnormalities. Outcome at discharge was; 8% died, 49% improved with neurological sequelae and 43% improved without sequelae. Having TBM stage 3 at admission was associated with mortality (p=0.001). Most children had early diagnosis of TBM and mortality was lower than in previous studies. We recommend a larger prospective study to further understand the outcome of TBM.

Highlights

Tuberculosis (TB) is a major public-health problem with around 9 million new cases and 2 million deaths estimated to occur each year. 1 About one-third of the world’s population has latent TB with a lifetime risk of TB disease of 10%.2 among those coinfected with HIV and latent TB infection, the risk for TB reactivation is 10% per year.[3]
Of 22,943 children admitted to Red Cross War memorial Children’s Hospital (RCWMCH) during the study period, we identified 40 children newly diagnosed with tuberculous meningitis (TBM); an incidence rate of 1.7 per 1000 admissions
Other tests done to make a diagnosis of tuberculosis including Mantoux test, chest X-rays, sputum smear and culture, and Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) are summarized in table 3 below

Summary

Introduction

Tuberculosis (TB) is a major public-health problem with around 9 million new cases and 2 million deaths estimated to occur each year. 1 About one-third of the world’s population has latent TB with a lifetime risk of TB disease of 10%.2 among those coinfected with HIV and latent TB infection, the risk for TB reactivation is 10% per year.[3]. 1 About one-third of the world’s population has latent TB with a lifetime risk of TB disease of 10%.2 Among those coinfected with HIV and latent TB infection, the risk for TB reactivation is 10% per year.[3] About 20% of TB is extra-pulmonary disease.[4] Tuberculous meningitis is the most severe form of extra pulmonary tuberculosis. Diagnosis of tuberculous meningitis (TBM) is complicated and outcome is poor especially in resource limited settings. Methods:This retrospective study included children who were diagnosed with TBM in the year 2009. Conclusions: Most children had early diagnosis of TBM and mortality was lower than in previous studies.

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