Subject(s)
Humans , Male , Female , Adult , Young Adult , Rifampin/administration & dosage , Tuberculosis, Meningeal/drug therapy , AIDS-Related Opportunistic Infections/drug therapy , Levofloxacin/administration & dosage , Antitubercular Agents/administration & dosage , Rifampin/adverse effects , Tuberculosis, Meningeal/complications , Tuberculosis, Meningeal/mortality , HIV Infections/complications , Proportional Hazards Models , Double-Blind Method , Drug Resistance, Bacterial , Drug Therapy, Combination , Kaplan-Meier Estimate , Levofloxacin/adverse effects , Mycobacterium tuberculosis/drug effects , Antitubercular Agents/adverse effectsABSTRACT
Past decade has seen increase in cases of tuberculous meningitis [TBM] and multidrug resistance in such cases. The mortality rate for a mismanaged TBM is very high which increases manifold in presence of associated complicating factors. The present study was thus planned to evaluate the prevalence of MDR-TBM and look for associated complicating factors and carry out drug sensitivity pattern in all culture positive isolates. One hundred cerebro-spinal fluid [CSF] samples from children clinically suspected of having TBM were collected and processed for detection of Mycobacterium tuberculosis by conventional methods like Ziehl-Neelsen [ZN] staining, Lowenstein- Jensen [LJ] culture and newer method like BACTEC 460 TB culture. Antimicrobial susceptibility was performed on all culture positive isolates by BACTEC 460 TB system. Twenty two cases could be diagnosed as definitive TBM based on BACTEC culture. Of these 22 cases, six cases [27.3%] were positive by ZN staining and/or LJ culture. Of all isolates tested for drug sensitivity 18 were sensitive to all four drugs whereas 4 isolates were resistant to more than one drug. Since the prevalence of MDR-TBM is very high we conclude that all CSF samples should be subjected to sensitivity testing to diagnose it at an early time and determine its sensitivity pattern in view of its very high mortality
Subject(s)
Humans , Male , Female , Tuberculosis, Meningeal/cerebrospinal fluid , Tuberculosis, Meningeal/complications , Microbial Sensitivity Tests , Prevalence , Tuberculosis, Meningeal/mortality , Prospective Studies , Mycobacterium tuberculosis , ChildABSTRACT
Este é um estudo de prognóstico em que é avaliada uma coorte retrospectiva de 231 pacientes com diagnóstico de meningoencefalite tuberculosa, com o objetivo de determinar os fatores prognósticos de letalidade. A idade variou de menos de 1 a 68 anos, com 97 pacientes (42 por cento) na faixa etária igual ou inferior a 4 anos. Em 62 casos ocoreu a confirmaçao diagnóstica por líquor (cultura, baciloscopia, PCR) ou necropsia; nos demais casos o diagnóstico foi baseado em critérios clínicos, epidemiológicos e resposta terapêutica. Na análise multivariada observamos que os fatores prognósticos mais importantes foram: faixa etária menor que 4 anos, ocorrência de convulsao e alteraçoes de consciência consideradas graves.
Subject(s)
Adult , Child , Child, Preschool , Infant , Humans , Adolescent , Aged , Female , Meningoencephalitis/mortality , Tuberculosis, Meningeal/mortality , Analysis of Variance , Hospital Mortality , Prognosis , Retrospective Studies , Risk FactorsABSTRACT
BACKGROUND: This study aimed to identify the predictors of hospital mortality in children with acute infective disorders of the central nervous system using an aggregate Modified Glasgow Coma Scale (MGCS) score and other clinical variables assessed within 24 hours of hospitalization. METHODS: We did a prospective cohort study in a teaching and referral hospital in Lucknow, North India. Consecutive children aged 1 month to 12 years of age admitted with acute infective disorders of the central nervous system were included in the study. The diagnosis was based on the presence of symptoms of fever, headache or irritability with or without vomiting, and either altered sensorium or first episode of seizures or both. The main outcome measure was hospital-based mortality. RESULTS: Of the 230 patients included in the study, 42.2% had pyogenic meningitis, 36.9% had tuberculous basal meningitis and 20.9% had meningo-encephalitis. There were 43 (18.7%) deaths of which 44.2% were within 3 days of admission. Death was associated with the day 1 aggregate MGCS score only. The area under the curve of four strata of aggregate MGCS was 0.63 (SE 0.05). The likelihood ratio for discharge with an aggregate MGCS score of < 5 was 0.52 (95% CI:0.29-0.95) and > 10 was 5.52 (9% CI:1.02-31.96). CONCLUSION: The MGCS can be used to predict discharge in patients with acute infective disorders of the central nervous system within 24 hours of hospitalization. The scale is simple, can be applied at the bedside and does not depend on any investigations. In developing countries with limited investigative facilities it can be used for identification and selective referral of patients with a higher risk of death to specialized centres. This study validates the predictive value of the MGCS.
Subject(s)
Child , Child, Preschool , Cohort Studies , Data Interpretation, Statistical , Female , Glasgow Coma Scale , Hospital Mortality , Humans , India , Infant , Infant, Newborn , Male , Meningitis/mortality , Meningoencephalitis/mortality , Predictive Value of Tests , Prospective Studies , Tuberculosis, Meningeal/mortalityABSTRACT
Se realizó un estudio retrospectivo-prospectivo para conocer las características clínicas y la morbimortalidad de la meningoencefalitis tuberculosa (MEC TBC) del adulto. De 124 historias clínicas con ese diagnóstico en el Hospital Dos de Mayo de Lima entre 1985-1989, 97 cumplieron los criterios de inclusión. Se halló que la población más afectada fue de jóvenes, solteros, migrantes, de baja escolaridad y remuneración. La forma de presentación más frecuente fue de inicio insidioso (91.1 por ciento) y curso subagudo (59.4 por ciento): con contactos TBC, (29.1 por ciento): con antecedentes de TBC, (42.5 por ciento); hipoglucorraquia (53.6 por ciento), hiperproteinorraquia (95.2 por ciento), pleocitosis (98.9 por ciento); BK directo, 0 por ciento; con TBC pulmonar, 70.5 por ciento; PPD positivo, 36.0 por ciento; estadío moderado de enfermedad, 67.0 por ciento; tratamiento adecuado, 94.8 por ciento; corticoterapia, 79.4 por ciento; hospitalización mayor de 30 días, 42.2 por ciento; fallecidos, 30.9 por ciento; seguimiento ambulatorio, 59.7 por ciento; recaídas, 11.9 por ciento. Después del alta fueron ubicados 41 pacientes (61.2 por ciento), de los cuales 22 (53.7 por ciento), 9 (2l.9 por ciento), y 2 (4.8 por ciento) con categorías 1,2 y 3 respectivamente, más 8 (19.5 por ciento) fallecidos. Se concluye que la MEC TBC afecta a la población joven, de bajo nivel socioeconómico, que la mortalidad es alta, que la mortalidad al alta correlacionó con la edad y la condición clínica al ingreso, no correlacionó con otros factores. La morbimortalidad al seguimiento correlacionó con la edad y el tratamiento ambulatorio irregular
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Tuberculosis, Meningeal/diagnosis , Tuberculosis, Meningeal/etiology , Tuberculosis, Meningeal/mortality , Tuberculosis/complications , Tuberculosis/diagnosis , Indicators of Morbidity and Mortality , Morbidity , Mortality , Clinical Laboratory Techniques , Mycobacterium tuberculosis/pathogenicity , Antitubercular Agents/administration & dosage , Antitubercular Agents/therapeutic use , Signs and SymptomsABSTRACT
Se realizó un estudio retrospectivo-prospectivo para conocer las características clínicas y la morbimortalidad de la meningoencefalitis tuberculosa (MEC TBC) del adulto. De 124 historias clínicas con ese diagnóstico en el Hospital Dos de mayo de Lima entre 1985 - 1989, 97 cumplieron los criterios de inclusión. Se halló que la población más afectada fue de jóvenes, solteros, migrantes, de bajas escolaridades y renumeraciones. La forma de presentación más frecuente fue de inicio insidioso (91.1 por ciento) y curso subagudo (59.4 por ciento); con contactos TBC, (29.1 por ciento); con antecedentes de TBC, (42.5 por ciento); hipoglucorraquia (53.6 por ciento), hiperproteinorraquia (95.2 por ciento), pleocitosis (98.9 por ciento); BK directo, 0 por ciento; con TBC pulmonar, 70.5 por ciento; PPD positivo, 36.0 por ciento ; estadío moderado de enfermedad, 67.0 por ciento; tratamiento adecuado, 94.8 por ciento ; corticoterapia, 79.4 por ciento; hospitalización mayor de 30 días, 42.2 por ciento; fallecidos, 30.,9 por ciento; seguimiento ambulatorio, 59.7 por ciento; recaídas, 11.9 por ciento. Después del alta fueron ubicados 41 pacientes (61.2 por ciento), de los cuales 22 (53.7 por ciento), 9 (21.9 por ciento), y 2 (4.8 por ciento) con categorías 1, 2 y 3 respectivamente, más 8 (19.5 por ciento) fallecidos. Se concluye que la MEC TBC afecta a la población joven, de bajo nivel socioeconómico, que la mortalidad es alta, que la morbimortalidad al alta correlaciono con la edad y la condición clínica al ingreso, no correlacionó con otros factores. La morbimortalidad al seguimiento correlacionó con la edad y el tratamiento ambulatorio irregular
Subject(s)
Humans , Adult , Meningoencephalitis , Tuberculosis, Meningeal , Age Factors , Antitubercular Agents/therapeutic use , Meningoencephalitis/drug therapy , Meningoencephalitis/epidemiology , Meningoencephalitis/mortality , Peru , Retrospective Studies , Socioeconomic Factors , Tuberculosis, Meningeal/epidemiology , Tuberculosis, Meningeal/mortality , Tuberculosis, Meningeal/drug therapySubject(s)
Infant , Child, Preschool , Child , Humans , Tuberculosis, Meningeal/diagnosis , Tuberculosis, Meningeal/physiopathology , Tuberculosis, Meningeal/drug therapy , Tuberculosis/epidemiology , Isoniazid/therapeutic use , Pyrazinamide/therapeutic use , Radiography, Thoracic/methods , Tuberculosis, Meningeal/complications , Tuberculosis, Meningeal/epidemiology , Tuberculosis, Meningeal/immunology , Tuberculosis, Meningeal/cerebrospinal fluid , Tuberculosis, Meningeal/mortality , Tuberculosis, Pulmonary/transmissionABSTRACT
Se presentan los resultados de un estudio retrospectivo, realizado en la Unidad de Pediatría del Hospital General de México, SS, en pacientes que ingresaron con diagnóstico de meningitis tuberculosa durante el periodo de 1970 a 1985. Se estudiaron 26 casos cuyas edades límites fueron de 11 meses y 14 años, predominando los mayores de cuatro. Entre las manifestaciones clínicas, se observó que el 89% de los pacientes mostraron datos neurológicos y la mayoría con diversos grados de desnutrición. Los estudiados delaboratorio y gabinete confirmaron el diagnóstico. El examen citoquímico de líquido cefalorraquíneo (LCR) estuvo alterado en el 96.1%; la radiografía de tórax fue positiva en 57.6% de los casos; en cambio, el porcentaje de aislamiento del bacilo fue bajo. Se analizan también otros recursos para el diagnóstico, tratamiento, complicaciones, secuelas, mortalidad y prevención
Subject(s)
Infant , Child, Preschool , Child , Adolescent , Humans , Tuberculosis, Meningeal/etiology , Mexico , Tuberculosis, Meningeal/diagnosis , Tuberculosis, Meningeal/mortalityABSTRACT
The study of twenty tree cases of tuberculous meningitis shows that this illness affect frequenthy young child who's not vaccinate by the BCG, this child is infected by one member of this family in many cases The early diagnosis of this affection is important because the clinical board realised in the moment of the patients cure is dominate by the mental obnibulation and neuronegetative disorders- The Koch's bacillus is rarely found in cephalorachidian liquid and the diagnosis rest on: for one thing on the descovery of a lymphocytic meningitis and for another on the signes of tuberculous infection. The evolution of the illness is lethal in 40% of the cases, and in case of healing two thirds of patients kept some neurogenic sequeIs. The prevention of this dread offal illness rest the pratice of a correct vaccination by the B.C.G. the detection and the treatment of tuberculous patients