Bacillus Calmette-Guérin is a preventive factor in mortality of childhood tuberculous meningitis.
OBJECTIVE
Studies have been done that have focused on the efficacy of bacillus Calmette-Guérin (BCG) vaccination in the prevention of cases of childhood tuberculous meningitis (TBM). However the efficacy of the vaccination in the prevention of mortality has not been sufficiently evaluated. This study aimed to determine the main features of TBM cases in childhood and to evaluate the factors related to mortality, proving the protective effect of BCG vaccination in childhood TBM.


METHODS
In a retrospective approach, all consecutive cases of TBM in children that occurred between 1997 and 2005, at Dicle University Hospital, were studied. The following data were evaluated: demographic aspects, admission symptoms, radiology and laboratory findings, BCG vaccination status, tuberculin skin test (TST) positivity, and mortality rates.


RESULTS
In total, 172 cases of childhood TBM were evaluated (mean age 53.3±55.7 months; 109 boys (63.4%)). The majority of these cases (70.4%) had typical TBM symptoms on admission. BCG vaccination data were available for 152 (88.4%) cases and 29 of them (19.1%) were positive. The TST was performed for 143 patients (83.1%) and 28 (19.6%) were found positive. Hydrocephalus was identified in 118 patients (68.6%) on computed tomography examination. A shunt was placed in 79 cases (45.9%). In total, 24 patients (14.0%) died in the hospital. TST negativity was a significant factor for mortality (p=0.012). BCG positivity was found to be a preventive factor from mortality (p=0.05).


CONCLUSIONS
BCG vaccination is effective in the prevention of TBM-associated mortality in childhood. TST negativity may be a sign of a poor prognosis in TBM cases.
Department of Pediatrics, Medical Faculty, Dicle University, Diyarbakır 21280, Turkey. Electronic address: selvikelekci@gmail.com.
Selvi
S
Kelekçi
Department of Pediatrics, Medical Faculty, Dicle University, Diyarbakır 21280, Turkey.
Müsemma
M
Karabel
Department of Pediatrics, Medical Faculty, Dicle University, Diyarbakır 21280, Turkey.
Duran
D
Karabel
Department of Radiology, Medical Faculty, Dicle University, Diyarbakır, Turkey.
Cihat
C
Hamidi
Department of Infectious Diseases and Clinical Microbiology, Dicle University, Medical Faculty, Diyarbakir, Turkey.
Salih
S
Hoşoğlu
Department of Pediatrics, Medical Faculty, Dicle University, Diyarbakır 21280, Turkey.
M Fuat
MF
Gürkan
Department of Pediatrics, Medical Faculty, Dicle University, Diyarbakır 21280, Turkey.
M Ali
MA
Taş
D001500:BCG Vaccine / Q000008:administration & dosage / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006785:Hospitals, University; D006801:Humans; D006849:Hydrocephalus / Q000150:complications / Q000276:immunology / Q000401:mortality / Q000517:prevention & control*; D007223:Infant; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D016019:Survival Analysis; D014374:Tuberculin Test; D014390:Tuberculosis, Meningeal / Q000150:complications / Q000276:immunology / Q000401:mortality / Q000517:prevention & control*; D014421:Turkey / Q000453:epidemiology; D014611:Vaccination
D001500:BCG Vaccine
BCG; Mortality; TST; Tuberculous meningitis