Risk factors of neurodevelopmental delay in paediatric tuberculous meningitis
Date
2022-04
Authors
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Publisher
Stellenbosch : Stellenbosch University
Abstract
ENGLISH SUMMARY: Objective: Neurodevelopmental delay in children is one of the long-term complications of tuberculous meningitis (TBM) with significant social, financial and scholastic implications. The objective of the study was to assess the risk factors in children with case-defined TBM that could predict neurodevelopmental delay at the conclusion of anti-tuberculous treatment, after 6 months in HIV non-infected and 9 months in HIV
co-infected.
Methods: We conducted a retrospective cohort study of all the children diagnosed with TBM at a large academic hospital in 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, with cognitive impairment at conclusion of anti-tuberculous treatment.
Results: A total of 327 patients were included. The median age on admission was 28 months (interquartile range(IQR) 15-47) with females accounting for 159 (48.6%) and males 168 (51.4%).Of included participants 170 (52%) were HIV negative. Younger age at diagnosis was more likely to have lower IQ levels. Patients were more likely to have lower IQ levels if they had decreased level of consciousness (LOC) (OR=3.30, 95% CI: 1.80-6.05); brainstem dysfunction (OR=2.39, 95% CI: 1.42-4.02); motor function impairment (OR=1.96, 95% CI:1.14-3.39) and infarcts (OR=2.60, 95% CI: 1.53-4.42). Those with positive CSF culture results were less likely to have lower IQ levels (OR=0.38, 95% CI: 0.20-0.75)
Conclusion: This study demonstrated that demographic (age on admission) and clinical characteristics (decreased level of consciousness, impaired motor function, brainstem dysfunction, cerebral infarcts, negative cerebrospinal fluid (CSF) culture) were independent risk factors for lower IQ levels at treatment conclusion, in children with clinically-defined TBM.
AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar.
AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar.
Description
Thesis (MSc)--Stellenbosch University, 2022.