Secondary complications in tuberculous meningitis in children: A prospective cohort study from India

Abstract

Background : There is a paucity of data on nature and frequency of complications during the course of management of Tuberculous Meningitis (TBM) in developing countries. Methods : This was a single center prospectivecohort of children less than 12 years of age diagnosed with TBM from January 2011 to Aug 2015. Results : Out of 281 children with TBM, hydrocephalous was present 245 children out of which 206 children needed neurosurgical intervention.24.3%, 35.5 % and 40.2% were in stage 1, stage 2 and 3(MRC) respectively. 164children underwent ventriculo-peritoneal shunt, 32 external ventricular drainage, and 10 underwent Omayya chamber drainage. Major complications were Shunt infection/Ventriculitis-16(7.7%) and Shunt Block 11(5.3%), Shunt Tract hemmorhage 12(5.8%). Other complications that were noted includedpersisting hydrocephalous after shunt, post shunt hygroma, shunt fracture, CSF ascites/ pseudocyst, skin Problems at shunt site, and intraventricular hemorrhage. 59.6%(n=148) had serum sodium <135meq/L and 37% (n=92) had a serum sodium <130 meq/L. Furthermore, 3.6%(n=9) had cerebral salt wasting, 5.2%(n=13) had SIADH and 1.25%(n=3) had central diabetes insipidus. While more than one of these entities was seen in 3 children. Suspected hospital acquired sepsis needing adding of second line antibiotics was seen in 24.26% of the children. Conclusion : In this cohort of children in resource constraint setting who present with advanced hydrocephalous and severe encephalopathy, the major shunt complication rates like infection and malfunction were remarkably low compared to available literature.