NEUROLOGICAL COMPLICATIONS AND BACILLE CALMETTE-GUERIN VACCINATION STATUS OF CHILDREN WITH TUBERCULOUS MENINGITIS: A TERTIARY CARE HOSPITAL EXPERIENCE

Main Article Content

Bibi Aalia
Syed Sajid Hussain Shah

Abstract

OBJECTIVE: To assess for the neurological complications and Bacille Calmette-Guerin (BCG) vaccination status of children with tuberculosis meningitis (TBM).


METHODS: This retrospective study was conducted in Ayub Teaching Hospital, Abbottabad, Pakistan. Data of diagnosed case of TBM who received anti-tuberculous therapy from 2017 to 2020 was retrieved from records. Records of children, aged 6 months to 10 years of either gender were included and vaccination status was documented along with CT scan findings. Neurological complications in hospital and outcome were recorded as discharge, expiry and transfer to other hospital.


RESULTS: Out of 40 patients, 17 (42.5%) were males and 23 (57.5%) females. Age ranged from 6 months to 8 years with mean age of 2.81±2.29 years. Weight ranged from 5 to 24 kg and mean weight was 10.36±4.96 kg. About 72.5% patients were <5 years of age. About 47.5% (n=19/40) patients were not vaccinated for BCG. Primary source of tuberculosis in close contacts


was identified in 35% (n=14/40) patients. Common findings on CT scan were hydrocephalus (35.0%; n=14/40) & cerebral infarct (15.0%; n=6/40). The common complication observed were hydrocephalus (35%; n=14/40), acute stroke (20%; n=8/40), cranial nerve palsies (12.5%; n=5/40), seizure disorder (12.5%; n=5/40). Mortality rate was 2.5% (n=1/40). Only 35.7% (5/14) of patients with hydrocephalus and no patient with stroke or seizures were fully vaccinated.


CONCLUSION: Hydrocephalus & stroke are the most common complication in children with TBM. Neurological complications were observed more commonly in children who were either not vaccinated or partially vaccinated for BCG.

Article Details

How to Cite
Aalia, B., and S. Shah. “NEUROLOGICAL COMPLICATIONS AND BACILLE CALMETTE-GUERIN VACCINATION STATUS OF CHILDREN WITH TUBERCULOUS MENINGITIS: A TERTIARY CARE HOSPITAL EXPERIENCE”. KHYBER MEDICAL UNIVERSITY JOURNAL, Vol. 12, no. 4, Dec. 2020, pp. 305-9, doi:10.35845/kmuj.2020.20431.
Section
Original Articles

References

1. World Health Organization (WHO). Global tuberculosis report 2019. [Accessed on: May 17, 2020]. Available from URL: https://www.who.int/tb/publications/global_report/en/
2. Shah I, Pereira N. Tuberculous Meningitis in Children: a Review Article. Curr Infec Dis Rep 2020;22:11. DOI: 10.1007/s11908-020-0720-7.
3. Wang DM, Li QF, Zhu M, Wu GH, Li X, Xu YH, et al. Epidemiological, clinical characteristics and drug resistance situation of culture confirmed children TBM in southwest of China: a 6-year retrospective study. BMC Infect Dis 2020;20(1):318. DOI: 10.1186/s12879-020-05041-3.
4. Garg RK. Tuberculous meningitis. Acta Neurol Scand 2010;122:75–90. DOI: 10.1111/j.1600-0404.2009.01316.x.
5. Marais BJ, Schaaf HS. Childhood tuberculosis: an emerging and previously neglected problem. Infect Dis Clin North Am 2010;24:717-49.
6. Daniel BD, Grace GA, Natrajan M. Tuberculous meningitis in children: Clinical management & outcome. Indian J Med Res 2019;150(2):117-30. DOI: 10.4103/ijmr.IJMR_786_17.
7. Nataprawira HM, Wonoputri N. Obstacles facing tuberculosis treatment in children from a developing country: a hospital based study. Am J Epidemiol Infect Dis 2014;2(1):8–12. DOI: 10.12691/ajeid-2-1-2.
8. Anwar M, Ahmad A, Ahmad F, Mazhar A. Modified Kenneth Jones Criteria for Diagnosing Tuberculous Meningitis in Children. J Coll Physicians Surg Pak 2010;20(4):258-61.
9. Baveja CP, Gumma V, Jain M, Choudhary M, Talukdar B,Sharma VK. Newer methods over the conventional diagnostic tests for tuberculous meningitis: do they really help? Trop Doct 2009;39(1):18-20. DOI: 10.1258/td.2008.080082.
10. Chatterjee S. Brain tuberculomas, tubercular meningitis, and post-tubercular hydrocephalus in children. J Pediatr Neurosci 2011;6(Suppl 1):S96–S100. DOI:10.4103/1817-1745.85725.
11. Nataprawira HM, Ruslianti V, Solek P, Hawani D, Milanti M, Anggraeni R, et al. Outcome of tuberculous meningitis in children: the first comprehensive retrospective cohort study in Indonesia. Int J Tuberc Lung Dis 2016;20(7):909-14. DOI:10.5588/ijtld.15.0555.
12. Faried A, Putra SPS, Suradj EW, Trianto , Akbar RR, Nugraheni NK, et al. Characteristics and outcomes of pediatric tuberculous meningitis patients with complicated by hydrocephalus with or without tuberculoma at Regional Public Hospital Teluk Bintuni, West Papua, Indonesia. Inter Discip Neurosurg 2020;19:100609. DOI:10.1016/j.inat.2019.100609.
13. Syggelou A, Spyridis N, Benetatou K, Kourkouni E, Kourlaba G, Tsagaraki M, et al. BCG Vaccine Protection against TB Infection among Children Older than 5 Years in Close Contact with an Infectious Adult TB Case. J Clin Med 2020;9(10):3224. DOI: 10.3390/jcm9103224.
14. Afridi JK, Dar AS, Karim R, Younas M, Khan MA. To determine the accuracy of highly suspected Clinical features for the diagnosis of Tuberculous meningitis. Khyber J Med Sci 2015;8(2):192-6.
15. van Well GTJ, Paes BF, Terwee CB, Springer P, Roord JJ, Donald PR, et al. Twenty years of pediatric tuberculous meningitis: a retrospective cohort study in the western cape of South Africa. Pediatrics 2009;123(1):e1-e8. DOI:10.1542/peds.2008-1353.
16. Rashid A, ArifA, Anwar MW, Ali AS. A Retrospective Review of Tuberculosis among Children Admitted at Tertiary Care Center of Lahore, Pakistan. Pak J Med Health Sci 2018;12(2):775-7.
17. Qureshi S, Sohaila A, Hannan S, Sheikh MDA, Qamar FN. Comparison of Xpert MTB/RIF with AFB smear and AFB culture in suspected cases of paediatric tuberculosis in a tertiary care hospital, Karachi. J Pak Med Assoc 2019;69(09):1273-8.
18. Khan IM, Khan S, Laaser U. Tuberculous meningitis: a disease of fatal outcome in children. Eur J Pediatr 2003;162(4):281-2. DOI: 10.1007/s00431-003-1172-4.
19. Anjum N, Noureen N, Iqbal I. Clinical presentations and outcomes of the children with tuberculous meningitis: An experience at a tertiary care hospital. J Pak Med Assoc 2018;68(1):10-5.
20. Miftode EG, Dorneanu OS, Leca DA, Juganariu G, Teodor A, Hurmuzache M, et al. Tuberculous Meningitis in Children and Adults: A 10-Year Retrospective Comparative Analysis. PLoS One 2015;10(7):e0133477. DOI:10.1371/journal.pone.0133477.
21. Mihailidou E, Goutaki M, Nanou A, Tsiatsiou O, Kavaliotis J. Tuberculous meningitis in Greek children. Scand J Infect Dis 2012;44(5):337-43. DOI: 10.3109/00365548.2011.639030.