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Risk factors of poor developmental outcome in children with tuberculous meningitis
Caro-Lee Saal1, Priscilla Springer2, James A Seddon2,3
1Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Insights
Neurodevelopmental delay in children with tuberculous meningitis (TBM) is linked to factors like reduced consciousness and brainstem issues. Identifying these predictors aids in early prognostication and supportive care for better outcomes.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Neuroscience
Background:
- Childhood tuberculous meningitis (TBM) frequently results in long-term neurodevelopmental delay.
- Identifying risk factors for this delay is crucial for improving patient outcomes.
Purpose of the Study:
- To assess demographic, clinical, laboratory, and neuro-imaging risk factors associated with neurodevelopmental delay in children treated for TBM.
Main Methods:
- A retrospective cohort study was conducted involving 327 children diagnosed with TBM between 1985 and 2015.
- Cognitive impairment, defined as moderate-to-severe, was assessed post-treatment.
- Multivariate analysis examined associations between patient characteristics and poor developmental outcomes.
Main Results:
- Of 327 patients, 71 (21.7%) experienced poor developmental outcomes.
- Decreased level of consciousness, brainstem dysfunction, and radiological infarction were significant predictors of poor outcomes.
- Left hemispherical and bilateral strokes were also associated with adverse developmental results.
Conclusions:
- Neurological signs and radiological infarct characteristics are key predictors of poor neurodevelopmental outcomes in childhood TBM.
- Early identification of these predictors enables more accurate prognostication.
- Prompt initiation of supportive and rehabilitative measures can improve long-term cognitive function.
Background:
Neurodevelopmental delay is a significant long-term complication of childhood tuberculous meningitis (TBM). The objective of this study was to assess risk factors for neurodevelopmental delay in children with TBM.
Methods:
We conducted a retrospective cohort study of children diagnosed with TBM at Tygerberg Hospital, Cape Town, South Africa, over a 30-year period between 1985 and 2015. We assessed the relationship between demographic, clinical, laboratory and neuro-imaging characteristics, and cognitive impairment at the conclusion of anti-tuberculous treatment. Poor outcome was defined as moderate-to severe cognitive impairment.
Results:
A total of 327 TBM patients were included, 71 (21.7%) suffered a poor outcome. Multivariate analysis revealed that decreased level of consciousness (adjusted OR (aOR): 4.68; 95%CI: 2.43-13.88; p = 0.005), brainstem dysfunction (aOR: 3.20; 95%CI: 1.70-6.00; p < 0.001), and radiological infarction (aOR: 3.47; 95%CI: 1.87-6.45; p < 0.001) were associated with a poor developmental outcome. Left hemispherical (single and multiple) stroke and bilateral stroke were associated with poor developmental outcomes.
Conclusion:
Certain neurological signs as well as radiological infarct characteristics are important predictors of poor developmental outcome. Anticipation of the likely level of cognitive impairment at diagnosis allows more accurate prognostication and prompt institution of supportive and rehabilitative measures, after the acute illness.
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