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Clinical presentations, diagnosis, mortality and prognostic markers of tuberculous meningitis in Vietnamese children: a prospective descriptive study

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Bang, Nguyen Duc, Caws, Maxine ORCID: https://orcid.org/0000-0002-9109-350X, Truc, Thai Thanh, Duong, Tran Ngoc, Dung, Nguyen Huy, Ha, Dang Thi Minh, Thwaites, Guy E., Heemskerk, Doortje, Tarning, Joel, Merson, Laura, Toi, Pham Van, Farrar, Jeremy J., Wolbers, Marcel, Pouplin, Thomas and Day, Jeremy N. (2016) 'Clinical presentations, diagnosis, mortality and prognostic markers of tuberculous meningitis in Vietnamese children: a prospective descriptive study'. BMC Infectious Diseases, Vol 16, Issue 573.

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Abstract

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 32.5 months; sex distribution was equal. Median duration of symptoms was 18.5 days and time from admission to treatment initiation was 11 days. 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 >5 years) 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.

Item Type: Article
Subjects: WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WL Nervous System > WL 200 Meninges. Blood-brain barrier
WS Pediatrics > Diseases of Children and Adolescents > By System > WS 340 Nervous system
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI): https://doi.org/10.1186/s12879-016-1923-2
Depositing User: Julie Franco
Date Deposited: 19 Oct 2016 10:11
Last Modified: 06 Feb 2018 13:13
URI: https://archive.lstmed.ac.uk/id/eprint/6283

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