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. 2023 Apr;39(4):1029-1039.
doi: 10.1007/s00381-022-05791-2. Epub 2022 Dec 16.

Risk factors of poor developmental outcome in children with tuberculous meningitis

Caro-Lee Saal  1 , Priscilla Springer  2 , James A Seddon  2   3 , Ronald van Toorn  2 , Tonya M Esterhuizen  1 , Regan S Solomons  4
Affiliations

Risk factors of poor developmental outcome in children with tuberculous meningitis

Caro-Lee Saal et al. Childs Nerv Syst. 2023 Apr.

Abstract

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.

Keywords: Central nervous system; Neurodevelopmental delay; Risk factors; Tuberculosis.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Participants flowchart
Fig. 2
Fig. 2
Scatterplots of total IQ/DQ versus age at admission for tuberculous meningitis (TBM) stratified by A TBM stage, B depressed level of consciousness (LOC), C brainstem dysfunction, and D motor function impairment
Fig. 3
Fig. 3
Boxplots of Griffiths total IQ and sub-quotients compared to presence and site of radiological infarction
See this image and copyright information in PMC

References

    1. Global Tuberculosis Report . World Health Organization. Geneva: Switzerland; 2020.
    1. Graham SM, Donald PR. Death and disability: the outcomes of tuberculous meningitis. Lancet Infect Dis. 2014;14(10):902–904. doi: 10.1016/S1473-3099(14)70872-2. - DOI - PubMed
    1. Donald PR, Cotton MF, Hendricks MK, Schaaf HS, de Villiers JN, Willemse TE. Pediatric meningitis in the Western Cape Province of South Africa. J Trop Pediatr. 1996;42(5):256–261. doi: 10.1093/tropej/42.5.256. - DOI - PubMed
    1. van Well GT, Paes BF, et al. Twenty years of pediatric tuberculous meningitis: a retrospective cohort study in the western cape of South Africa. Pediatrics. 2009;123(1):e1–8. doi: 10.1542/peds.2008-1353. - DOI - PubMed
    1. Nelson LJ, Schneider E, Wells CD, Moore M. Epidemiology of childhood tuberculosis in the United States, 1993–2001: the need for continued vigilance. Pediatrics. 2004;114(2):333–341. doi: 10.1542/peds.114.2.333. - DOI - PubMed