Volume 28, Number 3—March 2022
Research
Treatment Outcomes of Childhood Tuberculous Meningitis in a Real-World Retrospective Cohort, Bandung, Indonesia
, Nelly A. Risan, Diah A. Wulandari, Sri Sudarwati, Ben J. Marais, Jasper Stevens, Jan-Willem C. Alffenaar, and Rovina Ruslami
Table 2
Laboratory and radiographic findings at admission of children with tuberculous meningitis treated at Hasan Sadikin Hospital, Bandung, Indonesia, 2011–2020*
| Characteristic | Total patients |
Age <5 y |
Age 5–14 y |
|||||
|---|---|---|---|---|---|---|---|---|
| No.† | Value | No.† | Value | No.† | Value | |||
| CSF analysis, median (IQR) | ||||||||
| Leukocytes, cells/µL | 276 | 44 (11–109) | 149 | 56 (14–117) | 127 | 40 (8–95) | ||
| Protein, mg/dL | 276 | 107 (60–239) | 151 | 103 (68–234) | 125 | 120 (46–248) | ||
| MN, % | 275 | 83 (60–96) | 151 | 81 (60–95) | 124 | 86 (64–98) | ||
| PMN, % | 275 | 15 (4–37) | 151 | 18 (5–40) | 124 | 12 (0.2–36) | ||
| Glucose, mg/dL | 269 | 47 (25–66) | 150 | 42 (20–67) | 119 | 52 (34–66) | ||
| CSF-to-plasma glucose ratio, median (IQR) |
241 |
0.4 (0.2–0.6) |
140 |
0.4 (0.2–0.6) |
101 |
0.5 (0.3–0.6) |
||
| Cerebral imaging‡ | ||||||||
| Hydrocephalus | 250 | 103 (41.2) | 136 | 64 (47.1) | 114 | 39 (34.2) | ||
| Basal meningeal enhancement | 250 | 131 (52.4) | 136 | 74 (54.4) | 114 | 57 (50.0) | ||
| Infarct | 250 | 25 (10.0) | 136 | 12 (8.8) | 114 | 13 (11.4) | ||
| Tuberculoma |
250 |
31 (12.4) |
136 |
17 (12.5) |
114 |
14 (12.3) |
||
| Chest radiography | ||||||||
| Miliary TB | 281 | 19 (6.8) | 152 | 10 (6.6) | 129 | 9 (7.0) | ||
| Other signs of active TB |
281 |
128 (45.6) |
152 |
66 (43.4) |
129 |
62 (48.1) |
||
| TST positive§ |
283 |
64 (22.6) |
153 |
37 (24.2) |
130 |
27 (20.8) |
||
| M. tuberculosis cultured from any source¶ |
267 |
26 (9.7) |
147 |
15 (10.2) |
120 |
11 (9.2) |
||
| AFB smear microscopy | ||||||||
| Positive from CSF | 272 | 6 (2.2) | 149 | 4 (2.7) | 123 | 2 (1.6) | ||
| Positive from any non-CSF sample# |
282 |
49 (17.4) |
152 |
23 (15.1) |
130 |
26 (20.0) |
||
| Xpert MTB/RIF testing** | ||||||||
| Positive from CSF | 140 | 48 (34.3) | 77 | 24 (31.2) | 63 | 24 (38.1) | ||
| Positive from gastric lavage | 212 | 71 (33.5) | 120 | 43 (35.8) | 92 | 28 (30.4) | ||
| Positive from sputum | 12 | 5 (41.7) | 2 | 0 | 10 | 5 (50.0) | ||
*Values are no. (%) or median (IQR) except as indicated. AFB, acid-fast bacilli; CSF, cerebrospinal fluid; IQR, interquartile rage; MN, mononuclear cells; PMN, polymorphonuclear cells; TB, tuberculosis; TST, tuberculin skin test. †Number of total patients for whom data were available (denominator). ‡Cerebral imaging results were obtained mostly from noncontrast brain computed tomography scan, or from magnetic resonance imaging, where available. §The median size of induration (minimum–maximum range) in patients with a positive TST result was 12 (10–30) mm and in patients with a negative TST result was 0 (0–8) mm. ¶Culture of M. tuberculosis from CSF is rarely performed in our setting, mostly because of the limited CSF volume available from lumbar puncture. From our experience, most of the non-CSF specimens were obtained from gastric lavage, and some specimens were obtained from sputum, but our data could not further specify the type of specimens used. Mycobacterial culture were mostly performed on solid media; the use of liquid culture media (MGIT, BACTEC) has only begun in recent years. #We could not further specify the types of non-CSF specimens used for AFB smear microscopy. **Data on Xpert MTB/RIF testing results have only been available since 2013.
1These first authors contributed equally to this article.