Clinical and epidemiological features of tuberculous meningo-encephalitis paediatric cases over 10years at a teaching clinical hospital in Romania
Abstract number: R2267
Barcsay Z., Ebetiuc I., Nicoara E., John J., Al Hanini S., Cerbu M., Crisan A.
Objective: Meningo-encephalitis caused by Mycobacterium tuberculosis still holds an important place among the central nervous system infections and represents a relevant part of the extrapulmonary localisation of this infection, by its diagnostic and therapeutic challenges.
Method: The patients were recorded by the personal data concerning age, sex, geographic provenance, epidemiological data regarding heredocollateral and their personal history regarding mycobacterial infection, clinical stage at presentation, time interval until the diagnosis and until starting tuberculostatic therapy. Cerebrospinal fluid samples were examined in dynamic before and during the therapy, using direct light microscopy with Ziehl-Nielsen coloration and solid cultures with Loewenstein-Jensen culture media. The imagistic evaluation (CT, MRI) was also applied. We have evaluated the clinical evolution, complication implying central nervous system and those associated with the tuberculostatic therapy. We overviewed the antituberculous therapy, and the resistance profile.
Results: The group was formed by 35 non HIV-infected paediatric patients aged from 18 months to 17 years, admitted during a period of 10 years in a teaching Clinical Hospital (1997 october-2008 october). 54.2% were boys and 45.8% were girls, originated from four districts in the western side of the country, 40% from the urban and 60% from the rural area. The range of the symptoms at presentation was very wide, from headache and fever, associated meningeal irritation signs to coma, cranial nerve paresis. The average time span until establishing the diagnosis and the begin of the correct treatment was 15 days. 88.5% of the patients were previously treated with different classes of antibiotics. 25.7% of the cases were complicated with hydrocephalia and we have confronted with toxic hepatitis related to the therapy in 14.2% of the patients. In 3 of the cases the strains were resistant to one or two of the major therapeutic agents. 74.3% of the patients fully recovered, while 25.7% remained with sequelae like hydrocephalia, blindness or paresis.
Conclusion: The physician should mantain a high degree of suspicion regarding this disease because any delay in commencing the right treatment is associated with a significantly more reserved outcome and important sequelae.
|Session name:||19th European Congress of Clinical Microbiology and Infectious Diseases|
|Location:||Helsinki, Finland, 16 - 19 May 2009|
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