Factors associated with in-hospital mortality in HIV-infected children treated for tuberculous meningitis hydrocephalus.

Endoscopic third ventriculostomy Infarcts Tuberculoma Ventriculoperitoneal shunt

Journal

Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery

ISSN: 1433-0350

Titre abrégé: Childs Nerv Syst

Pays: Germany

ID NLM: 8503227

Informations de publication

Date de publication:
15 Nov 2023

Historique:

received: 01 07 2023

accepted: 26 10 2023

medline: 15 11 2023

pubmed: 15 11 2023

entrez: 14 11 2023

Statut: aheadofprint

Résumé

The study aimed to investigate factors associated with in-hospital mortality in children diagnosed with tuberculous meningitis (TBM) hydrocephalus and HIV co-infection undergoing cerebrospinal fluid diversion procedures and their complications. Data were collected retrospectively and prospectively between 2007 and 2022. Data collected included demographics, clinical characteristics, antiretroviral therapy (ART) status, biochemistry results, CD4 count, radiology findings, CSF diversion procedures (and complications), length of hospital stay (LOHS), and in-hospital mortality. Thirty-one children were included, with a mean age of 6.7 ± 5.3 years and 67.7% males. Median admission Glasgow Coma Scale (GCS) was 11 (IQR 9-15). Hypertonia (64.5%) and seizures (51.6%) were frequently observed clinical characteristics. Sixty-one percent of children were on ART. Cerebral infarcts and extra-meningeal TB were diagnosed in 64.5% and 19.3% of cases, respectively. The median CD4 count was 151 (IQR 70-732) cells/µL. Surgical procedures included ventriculoperitoneal shunt (VPS) in 26 cases and endoscopic third ventriculostomy (ETV) in five children. VPS complication rate was 27%. No complications were reported for ETV. Median LOHS was 7 days (IQR 4-21). Eleven children (35.5%) died during admission. Factors associated with mortality included GCS (p = 0.032), infarcts (p = 0.004), extra-meningeal TB (p = 0.003), VPS infection (p = 0.018), low CD4 count (p = 0.009), and hyponatremia (p = 0.002). No statistically significant factors were associated with VPS complications. TBM hydrocephalus in HIV-infected children carries a high mortality. Clinicians in high-prevalence settings should have a high suspicion index and institute early treatment.

Identifiants

DOI: 10.1007/s00381-023-06205-7 PMID: 37964056

pubmed: 37964056

doi: 10.1007/s00381-023-06205-7

pii: 10.1007/s00381-023-06205-7

doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Informations de copyright

Références

Marais S, Pepper DJ, Schutz C, Wilkinson RJ, Meintjes G (2011) Presentation and outcome of tuberculous meningitis in a high HIV prevalence setting. PLoS ONE 6(5):e20077. https://doi.org/10.1371/journal.pone.0020077

doi: 10.1371/journal.pone.0020077 pubmed: 21625509 pmcid: 3098272

Tenforde MW, Gertz AM, Lawrence DS, Wills NK, Guthrie BL, Farquhar C, Jarvis JN (2020) Mortality from HIV-associated meningitis in sub-Saharan Africa: a systematic review and meta-analysis. J Int AIDS Soc 23(1):e25416. https://doi.org/10.1002/jia2.25416

doi: 10.1002/jia2.25416 pubmed: 31957332 pmcid: 6970088

Global and regional trends. https://data.unicef.org/topic/hivaids/global-regional-trends/ . (Last accessed 4 May 2023)

Fry SH, Barnabas SL, Cotton MF (2019) Tuberculosis and HIV-an update on the “cursed duet” in children. Front Pediatr 7:159. https://doi.org/10.3389/fped.2019.00159

doi: 10.3389/fped.2019.00159 pubmed: 32211351 pmcid: 7073470

Schaaf HS, Seddon JA (2021) Management of tuberculous meningitis in children. Paediatr Int Child Health 41(4):231–236. https://doi.org/10.1080/20469047.2021.1952818

doi: 10.1080/20469047.2021.1952818 pubmed: 34783305

Glynn JR (1998) Resurgence of tuberculosis and the impact of HIV infection. Br Med Bull 54(3):579–593. https://doi.org/10.1093/oxfordjournals.bmb.a011712

doi: 10.1093/oxfordjournals.bmb.a011712 pubmed: 10326286

Chiang SS, Khan FA, Milstein MB, Tolman AW, Benedetti A, Starke JR et al (2014) Treatment outcomes of childhood tuberculous meningitis: a systematic review and meta-analysis. Lancet Infect Dis 14(10):947–957. https://doi.org/10.1016/S1473-3099(14)70852-7

doi: 10.1016/S1473-3099(14)70852-7 pubmed: 25108337

Paliwal VK, Garg RK (2021) Hydrocephalus in tuberculous meningitis - pearls and nuances. Neurol India 69:S330–S335. https://doi.org/10.4103/0028-3886.332275

doi: 10.4103/0028-3886.332275 pubmed: 35102984

Aulakh R, Chopra S (2018) Pediatric tubercular meningitis: a review. J Pediatr Neurosci 13(4):373–382. https://doi.org/10.4103/JPN.JPN_78_18

doi: 10.4103/JPN.JPN_78_18 pubmed: 30937075 pmcid: 6413593

Walters E, Cotton MF, Rabie H, Schaaf HS, Walters LO, Marais BJ (2008) Clinical presentation and outcome of tuberculosis in human immunodeficiency virus infected children on antiretroviral therapy. BMC Pediatr 8:1. https://doi.org/10.1186/1471-2431-8-1

doi: 10.1186/1471-2431-8-1 pubmed: 18186944 pmcid: 2246130

Marais S, Meintjes G, Pepper DJ, Dodd LE, Schutz C, Ismail Z et al (2013) Frequency, severity, and prediction of tuberculous meningitis immune reconstitution inflammatory syndrome. Clin Infect Dis 56(3):450–460. https://doi.org/10.1093/cid/cis899

doi: 10.1093/cid/cis899 pubmed: 23097584

Pormohammad A, Nasiri MJ, Riahi SM, Fallah F (2018) Human immunodeficiency virus in patients with tuberculous meningitis: systematic review and meta-analysis. Trop Med Int Health 23(6):589–595. https://doi.org/10.1111/tmi.13059

doi: 10.1111/tmi.13059 pubmed: 29660820

Chalasani R, Goonathilake MR, Waqar S, George S, Jean-Baptiste W, Yusuf Ali A et al (2022) The outcome of surgical intervention (ventriculoperitoneal shunt and endoscopic third ventriculostomy) in patients with hydrocephalus secondary to tuberculous meningitis: a systematic review. Cureus 14(5):e25317. https://doi.org/10.7759/cureus.25317

doi: 10.7759/cureus.25317 pubmed: 35637922 pmcid: 9131440

Loan JJM, Poon MTC, Tominey S, Mankahla N, Meintjes G, Fieggen AG (2020) Ventriculoperitoneal shunt insertion in human immunodeficiency virus infected adults: a systematic review and meta-analysis. BMC Neurol 20(1):141. https://doi.org/10.1186/s12883-020-01713-4

doi: 10.1186/s12883-020-01713-4 pubmed: 32303190 pmcid: 7164262

Nadvi SS, Nathoo N, Annamalai K, van Dellen JR, Bhigjee AI (2000) Role of cerebrospinal fluid shunting for human immunodeficiency virus-positive patients with tuberculous meningitis and hydrocephalus. Neurosurgery 47:644–649. discussion 649–650. https://doi.org/10.1097/00006123-200009000-00024

Sharma RM, Pruthi N, Arimappamagan A, Somanna S, Devi BI, Pandey P (2015) Tubercular meningitis with hydrocephalus with HIV co-infection: role of cerebrospinal fluid diversion procedures. J Neurosurg 122(5):1087–1095. https://doi.org/10.3171/2014.12.JNS14257

doi: 10.3171/2014.12.JNS14257 pubmed: 25679277

Harrichandparsad R, Nadvi SS, Suleman Moosa MY, Rikus van Dellen J (2019) Outcome of ventriculoperitoneal shunt surgery in human immunodeficiency virus-positive patients on combination antiretroviral therapy with tuberculosis meningitis and hydrocephalus. World Neurosurg 123:e574–e580. https://doi.org/10.1016/j.wneu.2018.11.221

Marais S, Thwaites G, Schoeman JF, Török ME, Misra UK, Prasad K et al (2010) Tuberculous meningitis: a uniform case definition for use in clinical research. Lancet Infect Dis 10:803–812. https://doi.org/10.1016/S1473-3099(10)70138-9

doi: 10.1016/S1473-3099(10)70138-9 pubmed: 20822958

WHO consolidated guidelines on tuberculosis. Module 5: management of tuberculosis in children and adolescents. Geneva: World Health Organization; 2022. https://www.who.int/publications/i/item/9789240046764 . (Last accessed 20 May 2023)

National Department of Health. Guidelines for the management of tuberculosis in children. Pretoria, South Africa: Department of Health; 2013. https://knowledgehub.health.gov.za/system/files/elibdownloads/2023-04/National-Childhood-TB-Guidelines-2013-ZA.pdf . (Last accessed 21 July 2023)

van Toorn R, Springer P, Laubscher JA, Schoeman JF (2012) Value of different staging systems for predicting neurological outcome in childhood tuberculous meningitis. Int J Tuberc Lung Dis 16(5):628–632. https://doi.org/10.5588/ijtld.11.0648

doi: 10.5588/ijtld.11.0648 pubmed: 22410643

Figaji A, Fieggen G, Rohlwink U (2017) Hydrocephalus surgery in childhood tuberculous meningitis with hydrocephalus. In: Tuberculosis of the central nervous system: pathogenesis, imaging, and management. Springer International Publishing AG. 419–428

Yadav YR, Yadav N, Parihar V, Ratre S, Bajaj J (2017) Role of Endoscopic Ventriculostomy in tuberculous meningitis with hydrocephalus. In: Tuberculosis of the central nervous system: pathogenesis, imaging, and management. Springer International Publishing AG. 429–446

South Africa National Department of Health. Implementation of the universal teat and treat strategy for HIV positive patients and differentiated care for stable patients. Pretoria: South Africa National Department of Health. 2016. https://sahivsoc.org/Files/22%208%2016%20Circular%20UTT%20%20%20Decongestion%20CCMT%20Directorate.pdf . (Last accessed 29 April 2023)

World Health Organization (WHO). Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV. 2015. https://apps.who.int/iris/bitstream/handle/10665/186275/9789241509565_eng.pdf . (Last accessed 25 May 2023)

Misra UK, Kalita J, Bhoi SK, Singh RK (2016) A study of hyponatremia in tuberculous meningitis. J Neurol Sci 367:152–157. https://doi.org/10.1016/j.jns.2016.06.004

doi: 10.1016/j.jns.2016.06.004 pubmed: 27423581

Karande S, Gupta V, Kulkarni M, Joshi A, Rele M (2005) Tuberculous meningitis and HIV. Indian J Pediatr 72(9):755–760. https://doi.org/10.1007/BF02734147

doi: 10.1007/BF02734147 pubmed: 16186677

Topley JM, Bamber S, Coovadia HM, Corr PD (1998) Tuberculous meningitis and co-infection with HIV. Ann Trop Paediatr 18(4):261–266. https://doi.org/10.1080/02724936.1998

doi: 10.1080/02724936.1998 pubmed: 9924579

Marais S, Pepper DJ, Marais BJ, Török ME (2010) HIV-associated tuberculous meningitis–diagnostic and therapeutic challenges. Tuberculosis (Edinb) 90(6):367–374. https://doi.org/10.1016/j.tube.2010.08.006

doi: 10.1016/j.tube.2010.08.006 pubmed: 20880749

Bang ND, Caws M, Truc TT, Duong TN, Dung NH, Ha DT et al (2016) Clinical presentations, diagnosis, mortality and prognostic markers of tuberculous meningitis in Vietnamese children: a prospective descriptive study. BMC Infect Dis 16(1):573. https://doi.org/10.1186/s12879-016-1923-2

doi: 10.1186/s12879-016-1923-2 pubmed: 27756256 pmcid: 5070308

Grobbelaar M, van Toorn R, Solomons R (2018) Lumbar cerebrospinal fluid evolution in childhood tuberculous meningitis. J Child Neurol 33(11):700–707. https://doi.org/10.1177/0883073818785553

doi: 10.1177/0883073818785553 pubmed: 29983081

Rohlwink UK, Donald K, Gavine B, Padayachy L, Wilmshurst JM, Fieggen GA et al (2016) Clinical characteristics and neurodevelopmental outcomes of children with tuberculous meningitis and hydrocephalus. Dev Med Child Neurol 58(5):461–468. https://doi.org/10.1111/dmcn.13054

doi: 10.1111/dmcn.13054 pubmed: 26888419 pmcid: 4855638

Seipone ID, Singh R, Patel VB, Singh A, Gordon ML, Muema DM et al (2018) Tuberculous meningitis is associated with higher cerebrospinal HIV-1 viral loads compared to other HIV-1-associated meningitides. PLoS ONE 13(2):e0192060. https://doi.org/10.1371/journal.pone.0192060

doi: 10.1371/journal.pone.0192060 pubmed: 29394269 pmcid: 5796705

Rohlwink UK, Kilborn T, Wieselthaler N, Banderker E, Zwane E, Figaji AA (2016) Imaging features of the brain, cerebral vessels and spine in pediatric tuberculous meningitis with associated hydrocephalus. Pediatr Infect Dis J 35(10):e301–e310. https://doi.org/10.1097/INF.0000000000001236

doi: 10.1097/INF.0000000000001236 pubmed: 27213261 pmcid: 5024759

Rohlwink UK, Mauff K, Wilkinson KA, Enslin N, Wegoye E, Wilkinson RJ et al (2017) Biomarkers of cerebral injury and inflammation in pediatric tuberculous meningitis. Clin Infect Dis 65:1298–1307. https://doi.org/10.1093/cid/cix540

doi: 10.1093/cid/cix540 pubmed: 28605426 pmcid: 5815568

Clemente Morgado T, Kinsky M, Carrara H, Rothemeyer S, Semple P (2013) Prognostic value of computed tomography-evident cerebral infarcts in adult patients with tuberculous meningitis and hydrocephalus treated with an external ventricular drain. World Neurosurg 80(6):e255–e260. https://doi.org/10.1016/j.wneu.2012.09.021

doi: 10.1016/j.wneu.2012.09.021 pubmed: 23041069

Chatterjee S (2011) Brain tuberculomas, tubercular meningitis, and post-tubercular hydrocephalus in children. J Pediatr Neurosci 6:S96–S100. https://doi.org/10.4103/1817-1745.85725

Bovijn L, Solomons R, Marais S (2019) Neurological TB in HIV. In: HIV and tuberculosis, a formidable alliance. Springer International Publishing AG. 295–334

Lanzafame M, Vento S (2016) Tuberculosis-immune reconstitution inflammatory syndrome. J Clin Tuberc Other Mycobact Dis 11(3):6–9. https://doi.org/10.1016/j.jctube.2016.03.002

doi: 10.1016/j.jctube.2016.03.002

van Toorn R, Rabie H, Dramowski A, Schoeman JF (2012) Neurological manifestations of TB-IRIS: a report of 4 children. Eur J Paediatr Neurol 16(6):676–682. https://doi.org/10.1016/j.ejpn.2012.04.005

doi: 10.1016/j.ejpn.2012.04.005 pubmed: 22658306

Hall WA, Turgut AT, Turgut M (2017) Surgical therapy of tuberculosis of the nervous system and its covering. In: Tuberculosis of the central nervous system: pathogenesis, imaging, and management. Springer International Publishing AG. 401–417

Goga A, Chirinda W, Ngandu NK, Ngoma K, Bhardwaj S, Feucht U et al (2018) Closing the gaps to eliminate mother-to-child transmission of HIV (MTCT) in South Africa: understanding MTCT case rates, factors that hinder the monitoring and attainment of targets, and potential game changers. S Afr Med J 108:S17–S24. https://doi.org/10.7196/SAMJ.2018.v108i3.12817

doi: 10.7196/SAMJ.2018.v108i3.12817

Gulen ST, Turgut M, Gulec GU, Turgut AT, Akhaddar A (2017) Medical therapy. In: Tuberculosis of the central nervous system: pathogenesis, imaging, and management. Springer International Publising AG. 391–398

Agrawal D, Gupta A, Mehta VS (2005) Role of shunt surgery in pediatric tubercular meningitis with hydrocephalus. Indian Pediatr 42(3):245–250

pubmed: 15817972

Lamprecht D, Schoeman J, Donald P, Hartzenberg H (2001) Ventriculoperitoneal shunting in childhood tuberculous meningitis. Br J Neurosurg 15:119–125. https://doi.org/10.1080/02688690020036801

doi: 10.1080/02688690020036801 pubmed: 11360374

Kankane VK, Gupta TK, Jaiswal G (2016) Outcome of ventriculoperitoneal shunt surgery, without prior placement of external ventricular drain in Grades III and IV patients of tubercular meningitis with hydrocephalus: a single institution’s experience in the pediatric population and review of literature. J Pediatr Neurosci 11(1):35–41. https://doi.org/10.4103/1817-1745.181265

doi: 10.4103/1817-1745.181265 pubmed: 27195031 pmcid: 4862286

Aranha A, Choudhary A, Bhaskar S, Gupta LN (2018) A randomized study comparing endoscopic third ventriculostomy versus ventriculoperitoneal shunt in the management of hydrocephalus due to tuberculous meningitis. Asian J Neurosurg 13(4):1140–1147. https://doi.org/10.4103/ajns.AJNS_107_18

doi: 10.4103/ajns.AJNS_107_18 pubmed: 30459883 pmcid: 6208215

Figaji AA, Fieggen AG, Peter JC (2007) Endoscopy for tuberculous hydrocephalus. Childs Nerv Syst 23(1):79–84. https://doi.org/10.1007/s00381-006-0195-3

doi: 10.1007/s00381-006-0195-3 pubmed: 17058085

Legaspi GD, Espiritu AI, Omar AT (2021) Success and complication rates of endoscopic third ventriculostomy for tuberculous meningitis: a systematic review and meta-analysis. Neurosurg Rev 44(4):2201–2209. https://doi.org/10.1007/s10143-020-01396-y

doi: 10.1007/s10143-020-01396-y pubmed: 32974813

Goyal P, Srivastava C, Ojha BK, Singh SK, Chandra A, Garg RK, Srivastava S (2014) A randomized study of ventriculoperitoneal shunt versus endoscopic third ventriculostomy for the management of tubercular meningitis with hydrocephalus. Childs Nerv Syst 30:851–857. https://doi.org/10.1007/s00381-014-2371-1

doi: 10.1007/s00381-014-2371-1 pubmed: 24493368