Publication: Clinical presentations, diagnosis, mortality and prognostic markers of tuberculous meningitis in Vietnamese children: A prospective descriptive study
Issued Date
2016-10-18
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ISSN
14712334
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2-s2.0-84992461037
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Mahidol University
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SCOPUS
Bibliographic Citation
BMC Infectious Diseases. Vol.16, No.1 (2016)
Suggested Citation
Nguyen Duc Bang, Maxine Caws, Thai Thanh Truc, Tran Ngoc Duong, Nguyen Huy Dung, Dang Thi Minh Ha, Guy E. Thwaites, Doortje Heemskerk, Joel Tarning, Laura Merson, Pham Van Toi, Jeremy J. Farrar, Marcel Wolbers, Thomas Pouplin, Jeremy N. Day Clinical presentations, diagnosis, mortality and prognostic markers of tuberculous meningitis in Vietnamese children: A prospective descriptive study. BMC Infectious Diseases. Vol.16, No.1 (2016). doi:10.1186/s12879-016-1923-2 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/41054
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Title
Clinical presentations, diagnosis, mortality and prognostic markers of tuberculous meningitis in Vietnamese children: A prospective descriptive study
Abstract
© 2016 The Author(s). Background: Tuberculous meningitis in adults is well characterized in Vietnam, but there are no data on the disease in children. We present a prospective descriptive study of Vietnamese children with TBM to define the presentation, course and characteristics associated with poor outcome. Methods: A prospective descriptive study of 100 consecutively admitted children with TBM at Pham Ngoc Thach Hospital, Ho Chi Minh City. Cox and logistic regression were used to identify factors associated with risk of death and a combined endpoint of death or disability at treatment completion. Results: The study enrolled from October 2009 to March 2011. Median age was 32.5months; sex distribution was equal. Median duration of symptoms was 18.5days and time from admission to treatment initiation was 11days. Fifteen of 100 children died, 4 were lost to follow-up, and 27/81 (33%) of survivors had intermediate or severe disability upon treatment completion. Microbiological confirmation of disease was made in 6%. Baseline characteristics associated with death included convulsions (HR 3.46, 95CI 1.19-10.13, p=0.02), decreased consciousness (HR 22.9, 95CI 3.01-174.3, p<0.001), focal neurological deficits (HR 15.7, 95CI 1.67-2075, p=0.01), Blantyre Coma Score (HR 3.75, 95CI 0.99-14.2, p<0.001) and CSF protein, lactate and glucose levels. Neck stiffness, MRC grade (children aged >5years) and hydrocephalus were also associated with the combined endpoint of death or disability. Conclusions: Tuberculous meningitis in Vietnamese children has significant mortality and morbidity. There is significant delay in diagnosis; interventions that increase the speed of diagnosis and treatment initiation are likely to improve outcomes.