Clinical and radiological prognostic indicators in childhood tuberculous meningitis

Tuberculous meningitis (TBM), the severest form of tuberculosis, continues to affect children in India. The disease has a high rate of mortality and disabling consequences. Scarce literature exists on prognostic indicators in children and none on radiological prognostic features. Our aim is to delineate clinical, laboratory and radiological prognostic indicators in childhood TBM. Children with TBM diagnosed according to pre-decided criteria and admitted to a teaching hospital in Northern India were enrolled for study. Demographic, clinical, laboratory and radiologic features at admission were charted. Patients were followed up to 3 months from discharge or until death. Features at admission were compared between those with good and bad outcome by univariate and logistic regression analysis. A total of 53 of 68 enrolled children were followed for 3 months. Significant factors on univariate analysis were age, headache, Glasgow coma score (GCS), muscle tone, extensor plantar response, decerebrate posturing, clinical stage of disease and infarcts on computerized tomography scan head. On logistic regression, only age <= 3 yr, GCS < 10 and increased muscle tone were significantly associated with bad outcome. Younger age, lower GCS and increased muscle tone at initial diagnosis are significant independent predictors of bad outcome in TBM in children.