Predictors of outcomes in children with Central Nervous System tuberculosis

Sushant S Mane; Jyothi Janardhanan; Sharanya Ramakrishnan; Aniruddh Shah; Manas Pustake; Anindita R Mandal

doi:10.1016/j.ijtb.2021.06.005

Predictors of outcomes in children with Central Nervous System tuberculosis

Indian J Tuberc. 2022 Apr;69(2):166-171. doi: 10.1016/j.ijtb.2021.06.005. Epub 2021 Jun 17.

Authors

Sushant S Mane¹, Jyothi Janardhanan¹, Sharanya Ramakrishnan¹, Aniruddh Shah¹, Manas Pustake², Anindita R Mandal¹

Affiliations

¹ Department of Paediatrics, Grant Government Medical College and Sir JJ Group of Hospitals, Byculla, Mumbai, 400008, India.
² Department of Paediatrics, Grant Government Medical College and Sir JJ Group of Hospitals, Byculla, Mumbai, 400008, India. Electronic address: pustakemanas@gmail.com.

PMID: 35379397
DOI: 10.1016/j.ijtb.2021.06.005

Abstract

Background: Central Nervous system tuberculosis (CNS-Tb) is the most lethal form of extra-pulmonary tuberculosis in children. The lack of markers of outcome provides little information on the efficacy of the current treatment protocols for CNS-Tb and thus results in a higher mortality rate than other extrapulmonary manifestations of tuberculosis. This study aims to identify significant factors that will reliably predict the outcomes at discharge in children admitted with CNS-Tb.

Methods and material: This is a prospective observational study in children with neurotuberculosis admitted at a tertiary care hospital. Clinical presentations at the time of admission were studied. Outcomes at the end of in-patient care (completely cured, survival with some/severe disability or death) were correlated with clinical, laboratory, microbiological, and radiological parameters. Univariate and multivariate analyses were applied to study the parameters and a p-value ≤ 0.05 with a confidence interval (CI) of 95% was considered as statistically significant.

Findings: The study included 100 children between 4 months and 12 years of age with a mean of 5.84 (±3.5) years. At discharge, 55% of children recovered completely, 20% had some or severe disability and 25% died. On multivariate analysis, high CSF protein (p = 0.050) and drug resistance (p = 0.034) were highly associated with fatality. Meningeal enhancements with basal exudates (p = 0.021) and CSF lymphocyte count >90% were highly associated with survival with disability. Stage I disease at presentation (p < 0.0001) was the only variable associated with complete recovery.

Interpretation: Reliable prognostic markers for CNS-Tb can aid in predicting the efficacy of the current treatment and the anticipated outcome in the children with this disease.

Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Keywords: CSF lymphocytes; CSF proteins; Determinants; Neurotuberculosis; Tuberculous meningitis.

Publication types

Observational Study

MeSH terms

Child
Child, Preschool
Hospitalization
Humans
Prospective Studies
Tuberculosis*
Tuberculosis, Central Nervous System* / diagnosis
Tuberculosis, Central Nervous System* / drug therapy