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Predictors of outcomes in children with Central Nervous System tuberculosis
Sushant S Mane1, Jyothi Janardhanan1, Sharanya Ramakrishnan1
1Department of Paediatrics, Grant Government Medical College and Sir JJ Group of Hospitals, Byculla, Mumbai, 400008, India.
Insights
Predicting outcomes in pediatric Central Nervous system tuberculosis (CNS-Tb) is crucial. High CSF protein and drug resistance indicate fatality, while meningeal enhancement and high CSF lymphocyte counts suggest disability, and early-stage disease predicts recovery.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Tuberculosis Research
Background:
- Central Nervous system tuberculosis (CNS-Tb) is the most fatal form of extrapulmonary tuberculosis in children.
- Lack of outcome markers hinders assessment of current CNS-Tb treatment efficacy, leading to high mortality rates.
- This study aimed to identify reliable predictors of outcomes in children with CNS-Tb.
Purpose of the Study:
- To identify significant factors that reliably predict outcomes at discharge in pediatric patients with CNS-Tb.
- To correlate clinical, laboratory, microbiological, and radiological parameters with patient outcomes.
- To improve prognostic accuracy for CNS-Tb in children.
Main Methods:
- Prospective observational study of 100 children diagnosed with neurotuberculosis.
- Clinical presentations, laboratory results, microbiological data, and radiological findings were analyzed.
- Univariate and multivariate analyses were employed to determine statistically significant predictors (p ≤ 0.05).
Main Results:
- High cerebrospinal fluid (CSF) protein and drug resistance were significantly associated with fatality (p=0.050 and p=0.034, respectively).
- Meningeal enhancement with basal exudates and CSF lymphocyte count >90% correlated with survival with disability (p=0.021).
- Stage I disease at presentation was the sole predictor of complete recovery (p < 0.0001).
Conclusions:
- Identifying reliable prognostic markers for CNS-Tb is essential for predicting treatment efficacy and patient outcomes.
- These markers can guide clinical management and potentially reduce mortality and disability in pediatric CNS-Tb cases.
- Further research into these prognostic factors can optimize therapeutic strategies.
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.
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