Predictors of Neurological Outcome of Tuberculous Meningitis in Childhood: A Prospective Cohort Study From a Developing Country

• Published in: Journal of child neurology 2016-12, Vol.31 (14), p.1622-1627
• Main Authors: Dhawan, Sumeet R., Gupta, Anju, Singhi, Pratibha, Sankhyan, Naveen, Malhi, Prahbhjot, Khandelwal, N.
• Format: Article
• Language: English
• Subjects: Antitubercular Agents - therapeutic use; Child, Preschool; Developing Countries; Disability Evaluation; Female; Follow-Up Studies; Humans; India; Infant; Male; Multivariate Analysis; Neuroimaging; Prednisone; Prospective Studies; Treatment Outcome; Tuberculosis, Meningeal - diagnosis; Tuberculosis, Meningeal - mortality; Tuberculosis, Meningeal - therapy
• ISSN: 0883-0738; 1708-8283
• DOI: 10.1177/0883073816668112

Aims: To assess the long-term outcome of childhood tuberculous meningitis treated with modern 4-drug antitubercular regimens and to determine predictors of survival and morbidity. Methods: In this single-center prospective cohort, outcome of children with tuberculous meningitis treated with standard regimens was assessed at 6 months and 12 months after discharge using the Pediatric Cerebral Performance Category Scale. Results: Of 130 children, 38 died in hospital and 34 were either severely disabled or comatose/vegetative at discharge. At 6 and 12 months, 87% of the survivors were either normal (n = 62) or mildly disabled (n = 17, on the Pediatric Cerebral Performance Category scale). On multivariate analysis, the factors associated with poor outcome at 12 months were stage III at admission (adjusted odds ratio 4.4, 95% confidence interval, 1.7-11.2, P = .002) and presence of infarcts on neuroimaging (adjusted odds ratio 2.6, 95% confidence interval, 1.1-6.6, P = .037). Conclusions: Despite the high in-hospital mortality, in resource-constraint settings, the survivors showed remarkable improvement, with two-thirds returning to a normal functional status at 6 months’ follow-up.