Treatment Outcomes of Childhood Tuberculous Meningitis in a Real-World Retrospective Cohort, Bandung, Indonesia

Heda M Nataprawira,Sri Sudarwati,Jasper Stevens,Rovina Ruslami,Diah A Wulandari,Fajri Gafar,Ben J Marais,Nelly A Risan,Jan-Willem C Alffenaar

doi:10.3201/eid2803.212230

Abstract

We retrospectively evaluated clinical features and outcomes in children treated for tuberculous meningitis (TBM) at Hasan Sadikin Hospital, Bandung, Indonesia, during 2011–2020. Among 283 patients, 153 (54.1%) were <5 years of age, and 226 (79.9%) had stage II or III TBM. Predictors of in-hospital death (n = 44 [15.5%]) were stage III TBM, hydrocephalus, male sex, low-income parents, seizures at admission, and lack of bacillus Calmette-Guérin vaccination. Predictors of postdischarge death (n = 18 [6.4%]) were hydrocephalus, tuberculoma, and lack of bacillus Calmette-Guérin vaccination. At treatment completion, 91 (32.1%) patients were documented to have survived, of whom 33 (36.3%) had severe neurologic sequelae and 118 (41.7%) had unknown outcomes. Predictors of severe neurologic sequelae were baseline temperature >38°C, stage III TBM, and baseline motor deficit. Despite treatment, childhood TBM in Indonesia causes substantial neurologic sequelae and death, highlighting the importance of improved early diagnosis, better tuberculosis prevention, and optimized TBM management strategies.

Highlights

We retrospectively evaluated clinical features and outcomes in children treated for tuberculous meningitis (TBM) at Hasan Sadikin Hospital, Bandung, Indonesia, during 2011–2020
Clinical Characteristics During the study period (2011–2020), 286 children with TBM were treated at Hasan Sadikin Hospital; 3 patients with rifampin-resistant TB were excluded
Our overall case-fatality rate for childhood TBM (22.8%) is within the global estimates reported in a recent meta-analysis (19.3% [95% CI 14.0%–26.1%]) [2] but is lower than that reported in the same setting during 2007–2010 (34.4%) [14]

Summary

Introduction

We retrospectively evaluated clinical features and outcomes in children treated for tuberculous meningitis (TBM) at Hasan Sadikin Hospital, Bandung, Indonesia, during 2011–2020. Summary estimates of neurologic sequelae and death associated with childhood TBM have been described in a meta-analysis, but predictors of these poor outcomes other than diagnosis in the most advanced disease stage were reported to have high heterogeneities across studies [2]. In settings in Indonesia, a few small studies have reported clinical outcomes of childhood TBM [14–16], but none have explored factors associated with the outcomes. Childhood TB Meningitis, Bandung, Indonesia in this vulnerable population In this context, our study aimed to assess clinical features of childhood TBM and to evaluate factors associated with poor outcomes, including in-hospital death, postdischarge death, and neurologic sequelae

Methods

Results

Conclusion