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Volume 28, Number 3—March 2022
Research

Treatment Outcomes of Childhood Tuberculous Meningitis in a Real-World Retrospective Cohort, Bandung, Indonesia

Heda M. Nataprawira1, Fajri Gafar1Comments to Author , Nelly A. Risan, Diah A. Wulandari, Sri Sudarwati, Ben J. Marais, Jasper Stevens, Jan-Willem C. Alffenaar, and Rovina Ruslami
Author affiliations: Hasan Sadikin Hospital, Bandung, Indonesia (H.M. Nataprawira, N.A. Risan, D.A. Wulandari, S. Sudarwati); Universitas Padjadjaran, Bandung, Indonesia (H.M. Nataprawira, N.A. Risan, D.A. Wulandari, S. Sudarwati, R. Ruslami); University of Groningen, Groningen, the Netherlands (F. Gafar, J. Stevens); Children’s Hospital at Westmead, Sydney, New South Wales, Australia (B.J. Marais); University of Sydney, Sydney (B.J. Marais, J.-W.C. Alffenaar); Westmead Hospital, Sydney (J.-W.C. Alffenaar)

Main Article

Table 1

Demographic and clinical characteristics at admission of children with TBM treated at Hasan Sadikin Hospital, Bandung, Indonesia, 2011–2020*

Characteristic Total patients
<5 y
5–14 y
No.† Value No.† Value No.† Value
Age, y , median (IQR)
283
4.0 (1.0; 10.0)

153
1.0 (0.7–2.4)

130
10.2 (8.0–12.2)
Sex
M 283 150 (53.0) 153 74 (48.4) 130 76 (58.5)
F
283
133 (47.0)

153
79 (51.6)

130
54 (41.5)
Nutritional status‡
WFAZ, median (IQR) 227 −2.2 (−3.0 to −1.0) 153 −1.9 (−2.9 to −0.7) 74 −2.5 (−3.2 to −1.7)
HFAZ, median (IQR) 283 −1.6 (−2.6 to −0.3) 153 −1.6 (−2.8 to −0.7) 130 −1.6 (−2.5 to −0.4)
BFAZ, median (IQR) 283 −2.1 (−3.2 to −0.4) 153 −1.7 (−2.8 to −0.2) 130 −2.6 (−3.7 to −0.5)
Moderately malnourished 283 74 (26.1) 153 44 (28.8) 130 30 (23.1)
Severely malnourished
283
109 (38.5)

153
47 (30.7)

130
62 (47.7)
Known BCG vaccination
283
223 (78.8)

153
120 (78.4)

130
103 (79.2)
Known TB contact history
283
73 (25.8)

153
36 (23.5)

130
37 (28.5)
Known HIV co-infection
283
4 (1.4)

153
0 (0.0)

130
4 (3.1)
Baseline temperature, °C, median (IQR)
282
37.0 (36.8–37.9)

153
37.2 (36.9–38.0)

129
37.0 (36.8–37.8)
Symptoms duration, d, median (IQR)§
269
8 (7–11)

145
8 (7–10)

124
9 (7–12)
Symptoms
Fever 283 250 (88.3) 153 136 (88.9) 130 114 (87.7)
Severe headache 278 61 (21.9) 150 13 (8.7) 128 48 (37.5)
Muscle weakness 278 73 (26.3) 151 40 (26.5) 127 33 (26.0)
Altered consciousness 283 211 (74.6) 153 111 (72.5) 130 100 (76.9)
Seizures 282 155 (55.0) 153 84 (54.9) 129 71 (55.0)
Persistent cough 282 95 (33.7) 152 53 (34.9) 130 42 (32.3)
Poor weight gain or weight loss
279
105 (37.6)

151
51 (33.3)

128
54 (41.5)
Motor function
Hemiparesis 263 51 (19.4) 142 27 (19.0) 121 24 (19.8)
Quadriparesis
263
95 (36.1)

142
59 (41.5)

121
36 (29.8)
Cranial nerve palsy
277
48 (17.3)

149
31 (20.8)

128
17 (13.3)
Signs of upper motor neuron lesion
264
188 (71.2)

143
93 (65.0)

121
95 (78.5
Signs of raised intracranial pressure
283
47 (16.6)

153
29 (19.0)

130
18 (13.8)
TBM category¶
Definite 283 51 (18.0) 153 26 (17.0) 130 25 (19.2)
Probable 283 178 (62.9) 153 101 (66.0) 130 77 (59.2)
Possible
283
54 (19.1)

153
26 (17.0)

130
28 (21.5)
GCS, median (IQR)
283
12 (10–14)

153
12 (10–15)

130
12 (10–14)
TBM stage#
Stage I 283 57 (20.1) 153 35 (22.9) 130 22 (16.9)
Stage II 283 131 (46.3) 153 60 (39.2) 130 71 (54.6)
Stage III 283 95 (33.6) 153 58 (37.9) 130 37 (28.5)

*Values are no. (%) or median (IQR) except as indicated. BCG, bacillus Calmette-Guérin; BFAZ, body mass index-for-age Z-score; GCS, Glasgow Coma Scale; HFAZ, height-for-age Z-score; IQR, interquartile rage; TB, tuberculosis; TBM, tuberculous meningitis; WFAZ, weight-for-age Z-score. †Number of total patients for whom data were available (denominator). ‡In children <5 years of age, moderate malnutrition was defined as WFAZ or HFAZ ≥–3 but <–2 standard deviation (SD), and severe malnutrition as WFAZ or HFAZ <–3 SD. In children aged 5–14 y, moderate malnutrition was defined as HFAZ or BFAZ ≥–3 but <–2 SD, and severe malnutrition as HFAZ or BFAZ <–3 SD. §Duration of symptoms before admission. ¶Diagnostic certainty was categorized as definite TBM (microbiologically proven from CSF examination), probable TBM (diagnostic score of ≥10 when neuroimaging was unavailable or ≥12 when neuroimaging was available), and possible TBM (diagnostic score of 6–9 when neuroimaging was unavailable or 6–11 when neuroimaging was available) (18). #TBM staging was classified according to the modified British Medical Research Council grading system as stage I (GCS of 15 with no focal neurologic signs), stage II (GCS 11–14 or 15 with focal neurologic signs), or stage III (GCS ≤10) (20).

Main Article

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Main Article

1These first authors contributed equally to this article.

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Page updated: February 21, 2022
Page reviewed: February 21, 2022
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