| Trend of Tuberculous Meningitis since 1970 |
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Jeong A Park, Chang Weon Oh, Kyoung Sim Kim, Yong Wook Kim, Ki Bok Kim |
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Department of Pediatrics, Kwangju Christian Hospital, Kwangju, Korea |
| 1970년대 이후의 결핵성 뇌막염의 추이 |
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박정아, 오창원, 김경심, 김용욱, 김기복 |
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광주기독병원 소아과 |
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| Abstract |
Purpose
: The incidence of tuberculous meningitis has reportedly decreased from 4.2% in 1970
to 1.8% in 1990 in Korea; however, tuberculous meningitis, which spreads hematogenously,
claiming majority of mortality in childhood tuberculosis, still poses serious problems. This study
was performed to evaluate the recent trend of tuberculous meningitis.
Methods
: We compared with three groups of tuberculous meningitis, two were our previous
reports on tuberculous meningitis, 106 cases1) from 1971 to 1979 were assigned as group I, 60
cases2) from 1982 to 1988 as group II and we reviewed medical record of 16 cases from 1989
to 1994 as group III.
Results
:
1) The incidence of tuberculous meningitis among the total admitted patients in groups I, II, and
III were 0.92, 0.27, and 0.06%, decreasing with a slope of -0.063% per year, and a correlation
coefficient of -0.892.
2) The age proportion among children under age 1 year were 17.9, 8.3, and 6.3%, espectively
for three groups and those over age 9-10 years were 11.3, 13.4, and 43.8%, indicating that
proportion of under age 1 year declined, whereas it increased in older aged children.
3) The overall male to female ratio was 1.43 : 1, and peak seasonal incidence was not noted.
4) There was no differences in tuberculous family history with 41.5% in group I, and 43.8%
in group III; BCG vaccination rate was increased significantly from 16.0% in group I up to
68.6% in group III(p<0.001); and the positive tuberculin skin test reactivity significantly increased
from 29.6% in group I to 68.8% in group III(p<0.01).
5) On chest X-ray, the rate of finding tuberculous lesion did not significantly change among 3
groups with 69.8, 58.3, and 87.5%, while the rate of associated miliary tuberculosis was
significantly reduced with 36.8, 28.3, and 0%(p<0.05).
6) The cure rate was 65.1, 68.4, and 87.5%, respectively and the cure rate of clinical stage 3
improved from 36.1% in group I to 66.7% in group III, but they showed no significant
difference between groups(p>0.05). The mortality rate was 5.7, 14.9, and 12.5%, respectively and
there was no significant difference between groups(p>0.05).
7) Hospital days under 14 days were 67.9, 23.3, and 6.3%, respectively; those over 21 days
were 3.8, 45.0, and 68.8%, respectively, indicating the hospital days became prolonged(p<0.001).
8) Brain CT was performed in group III(13/16), with abnormal findings found in 84.6%. The
abnormal findings were hydrocephalus in 5 cases(26.3%, ventriculoperitoneal shunt was done in 3
cases); and basal cisternal enhancement, and infarction 3 cases each. Complication rate was not
improved with 35.0% in group I and 31.2% in group III.
Conclusion
: During 25 years, the incidence of tuberculous meningitis significantly decreased
with the increased BCG vaccination rate; and the age of the affected children tended to increase.
It is noted, however, that the mortality rate and neurologic complication of the affected children
were not substantially improved, stressing early diagnosis and vigorous treatment on tuberculosis
in children. |
| Key Words:
Tuberculous meningitis, Children |
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