ICNC Abstracts, ICNC 2018

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Clinico-epidemiological profile and outcome of pediatric neurotuberculosis: a retrospective cohort study
Biswaroop Chakrabarty, Vivek Sirolia, Mudit Aggarwal, Prashant Jauhari, Atin Kumar, Sheffali Gulati

Last modified: 2018-09-09

Abstract


Introduction

Neurotuberculosis constitutes a significant health care burden in India.

Method

Case records of children (n=78) diagnosed with neurotuberculosis between January 2012 and April 2017 in a tertiary care teaching center in North India were retrospectively reviewed and analyzed for demographic details, clinical presentation, radiological and laboratory parameters, management and outcome (using Pediatric Cerebral Performance Scale-PCPS).

Results

In the 78 cases (7.95+/-2.08 years; 41 boys), predominant symptoms were: vomiting (57%), headache (37%), fever (20%), encephalopathy (19%) and seizures (12%) and signs were: focal deficits (29%; cranial nerve palsy 16%, spasticity 12%, hemiparesis 10% and extrapyramidal features 8%) , Kernig’s sign (14%),  and papilledema (9%).

Analysis of CSF showed:120 cells/mm3 (IQR-42-305 cells/mm3-predominantly lymphocytic), CSF hypoglycorrhachia(mean 35.53+/-16.90% of blood sugar) and protein of 163.43+/-72.76 mg/dl.

Radiologically commonest was TBM (74%; 23% isolated, 47% with tuberculoma,4% with spinal arachnoiditis, 5% with opticochiasmaticarachnoiditis and 6% with vasculitis). Isolated tuberculoma and spinal TB were found in 24.5% and 1.5% respectively.

Median duration of ATT was 12 months(IQR 12-24 months)with an intensive phase of 3 months(IQR- 3-6 months). MDR TB was found in 1% and category 2 ATT was required in 15%. Overall 47% had hydrocephalus of which 19% required CSF diversion procedure.

At treatment completion, 89% children had good final outcome(PCPS1-2) with mortality of 4%.

Conclusion

Clinical suspicion with suggestive radiological findings is the mainstay for establishing diagnosis of Neurotuberculosis. Majority of children have good final outcome on timely initiation of ATT.


Keywords


neurotuberculosis, children, clinical profile

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