Predictors of Outcomes in Children with Central Nervous System Tuberculosis

Abstract

Abstract Background Central Nervous system tuberculosis (CNS–Tb) is the most lethal form of extra-pulmonary tuberculosis in children. The lack of markers of outcome provides little information on the efficacy of the current treatment protocols for CNS–Tb and thus results in a higher mortality rate than other extrapulmonary manifestations of tuberculosis. This study aims to identify significant factors that will reliably predict the outcomes at discharge in children admitted with CNS–Tb. Methods and material This is a prospective observational study in children with neurotuberculosis admitted at a tertiary care hospital. Clinical presentations at the time of admission were studied. Outcomes at the end of in-patient care (completely cured, survival with some/severe disability or death) were correlated with clinical, laboratory, microbiological, and radiological parameters. Univariate and multivariate analyses were applied to study the parameters and a p-value ≤ 0.05 with a confidence interval (CI) of 95% was considered as statistically significant. Findings The study included 100 children between 4 months and 12 years of age with a mean of 5.84 (±3.5) years. At discharge, 55% of children recovered completely, 20% had some or severe disability and 25% died. On multivariate analysis, high CSF protein (p\xa0=\xa00.050) and drug resistance (p\xa0=\xa00.034) were highly associated with fatality. Meningeal enhancements with basal exudates (p\xa0=\xa00.021) and CSF lymphocyte count >90% were highly associated with survival with disability. Stage I disease at presentation (p\xa0 Interpretation Reliable prognostic markers for CNS–Tb can aid in predicting the efficacy of the current treatment and the anticipated outcome in the children with this disease. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.