1 - Pediatria, Área de Pediatria Médica, Hospital Dona Estefania, Centro Hospitalar Universitário de Lisboa Central, Lisboa
2 - Unidade de Infecciologia Pediátrica, Área de Pediatria Médica, Hospital Dona Estefânia, Centro Hospitalar Lisboa Central, Lisboa
3 - Unidade de Neurologia, Área de Pediatria Médica, Hospital Dona Estefânia, Centro Hospitalar Lisboa Central, Lisboa
4 - Serviço de Imagiologia, Neurorradiologia, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central EPE, Lisboa, Portugal
- e-poster viewing 41st Annual Meeting of the European Society for Paediatric Infectious Diseases (ESPID). Maio 2023, Lisboa
Introduction: Central Nervous System Tuberculosis (CSNTb) has the highest morbidity of all tuberculosis manifestations. Neurological sequelae are described in more than 50%. Our aim is to characterise children with CSNTb admitted to a tertiary-level children’s hospital in Portugal, and compare patients with and without neurological sequelae.
Methods: Retrospective review of pediatric patients with CNSTb (diffuse and/or focal), admitted over a 12-year period (2011-2022). Severity of disease was classified according to the Modified Medical Research Council score. We defined neurological sequelae as any motor, sensory, cognitive or behavioural impairment that emerged during illness and persisted 12 months after.
Results: 11 children with CSNTb were identified. Median age was 10.0 years [0.5-16.0]; 2 (18%) were immigrants and 2 (18%) were not immunized with BCG. One patient had a definitive diagnosis; 6 were classified as probable cases, and 4 as possible cases; 64% had a severity score II or III. Fever, headache, meningism, and altered consciousness were the most frequent presentations (61%). TST was negative/indeterminate in all and 3 (27%) had a positive IGRA test. Mycobacterium tuberculosis was isolated in 3 (27%). The mean duration of antituberculosis therapy was 12 months [9-18]. No deaths were registered. 5 (45%) had neurological sequelae: 2 epilepsy, 1 hemiparesis, 1 ataxia, 1 global development delay, 1 learning disabilities, and 1 behavioral disorder. Patients with sequelae presented with a higher severity score at admission (p=0.02). No statistical difference was observed between groups regarding previous BCG vaccination.
Conclusions: CSNTb is difficult to diagnose, as signs and symptoms are nonspecific, and diagnostic tests are often negative. Although no mortality was registered, a substantially high proportion of patients had sequelae. Sequelae was associated to a higher severity score at presentation.
Palavras Chave: central nervous system tuberculosis, children, treatment outcome.