Children Tuberculous Meningitis: Clinical Features And Predictors Of Mortality

Objective: To study the main clinical features and predictors of mor-tality of children tuberculous meningitis (TBM).Methods: We presented a retrospective study of the TBM cases whichoccurred at Children’s Hospital of Chongqing Medical University betweenJan2008and Dec2013. According to the outcome of followed up, the cas-es were divided into two groups, named Groups death and Group survival.By compared the clinical features of two groups, and predictors associatedwith mortality were studied.Results:1. Generals: There were69cases in Group death and122cases inGroup survival.63.77%(44/69) of Group death and71.31%(87/122) ofGroup survival were from the rural areas.40.58%(28/69) of Group deathand38.52%(47/122) of Group survival were under3years old. There wereno significant difference in living environment and ages (P>0.05).2. Bacillus Calmette-Guerin (BCG):14cases (63.64%,14/32) inGroup death and33cases (89.19%,33/37) in Group survival under2yearsold had been vaccinated. It had significant difference (P<0.05). 3. Clinical manifestations:（1）The median time of onset was15days for both groups and pre-sented on difference (P>0.05).（2）Clinical symptoms: Febrile cases account for86.96%(60/69) and88.52%(108/122) in Group death and Group survival; convulsions werepresent in37.68%(26/69) and23.77%(29/122) of two groups;86.96%(60/69) and86.07%(105/122) cases complicated with meningeal irritationof two groups; disorder of consciousness cases accounted for60.87%(42/69) and29.51%(36/122) in two different groups. There were no notabledifference in febrile and meningeal irritation (P>0.05), but significant dif-ference in convulsions, disorder of consciousness (P<0.05).（3）Clinical stage:59.42%（41/69）cases in Group death and20.49%(25/122) cases in Group survival were in stage Ⅲ. It presented sig-nificantly difference (P<0.05).（4）The median length of stay was6days for Group death, obviouslyshorter than the23days in Group survival (P<0.01).4. Auxiliary examination:（1）Acid-fast bacillus：The positive rates of gastric juice and Cere-brospinal fluid(CSF) were26.83%(11/41),21.43%(9/42）in Group deathand28.28%(28/99),33.04%(78/115) in Group survival. No significantdifference between two groups appeared (P>0.05).（2）PPD: The positive rate was20.59%(7/34) in Group death, while it was40.00%(28/70) in Group survival (P<0.05).（3）CSF protein more than3g/L: There were11cases (24.44%,11/45)in Group death and12cases (10.08%,12/119) in Group survival, and it hadsignificant difference (P<0.05).（4）Chest X-ray or CT suggested pulmonary tuberculosis: There were37cases (56.92%,37/65) in Group death, and93cases (76.23%,93/122) inGroup survival.（5）Brain CT or MRI:49cases (41.18%,49/119) of Group survivalappeared the hydrocephalus. It was more common in Group death (59.02%,36/61)(P<0.05).5.Treatment:86.96%cases (60/69) of Group death had regular antituberculosis treatment, it was significantly more in Group survival(98.36%,120/122）(P<0.05).76.81%cases (53/69) in Group death and95.08%cases (116/122) in Group survival were treated with corticosteroids,it was significant different (P<0.05).The proportion of intrathecal injectionin Group death was31.88%(22/69), and it was obviously less than Groupsurvival (51.65%,63/122)(P<0.05).Conclusion:1. The TBM patients were mainly from the rural areas, and TBMmainly influence children under3years old.2. BCG vaccination could decrease the mortality of TBM childrenunder2years old. 3. The treatment of TBM was commonly late.4. The acid-fast bacillus smears of the gastric juice and the CSF withpositive rate between21%-33%were the first choice for search pathogen.5. More than50%TBM cases accompanied with pulmonary tubercu-losis. The chest radiograph could provide an important diagnosis basis.6. Prolonged hospitalization, regular anti tuberculosis treatment, usageof corticosteroid and intrathecal injection were effective in improvingprognosis.7. Stage Ⅲ, convulsions, disorder of consciousness, PPD negativity,hydrocephalus, CSF protein increased were closely related to death.8. The mortality of TBM children was mostly due to shorter length ofstay and later clinical stage.