Prognostic factors of tuberculous meningitis in children

Abstract

Objective: To define the characteristics of tuberculous meningitis (TBM) and to identify prognostic factors. Material and method: A retrospective chart review was performed in children under 14 years old diagnosed with TBM during 1992-2001(10 years). Microbiological and clinical criteria were as follows: isolation of Mycobacterium tuberculosis from cerebrospinal fluid (CSF), abnormality of CSF, positive Mantoux skin test, cranial computed tomography with hydrocephalus and basal arachnoiditis. Purulent meningitis was excluded. Outcomes were classified as good (complete recovery) and poor (death or permanent neurological sequelae). Results: A total of 22 cases met the inclusion criteria. The mean duration of fever preceding admission was 10 days. Body temperature was 38.3 + 0.5 degree Celsius. Ten cases (45.4%) had seizures. Clinical staging was categorized at admission as follows: stage I 8 cases (36.3%), stage II 10 cases (45.4%) and stage III 4 cases (18.2%). Among the 22 cases, 50% had BCG scar. 40.9% had close contagious TB contact. 36.4% had positive Mantoux skin test and 31.8% had abnormal chest x-rays. Regarding outcome, 7 cases (31.8%) had complete recovery. 1 case (4.5%) died and 14 cases (63.6%) had permanent neurological sequelae. The potential risk factor of poor outcome was age less than 4 years (p=0.002). Conclusion: TBM causes high morbidity. The potential risk factor of poor outcome was age less than 4 years. Prevention and surveillance of the risk group is important to reduce the incidence of disease and morbidity.

Keywords

• tuberculous meningitis
• prognostic factors