title: Clinical presentations, diagnosis, mortality and prognostic markers of tuberculous meningitis in Vietnamese children: a prospective descriptive study.
abstract: Tuberculous meningitis in adults is well characterized in Vietnam, but there are no data on the disease in children. We present a prospective descriptive study of Vietnamese children with TBM to define the presentation, course and characteristics associated with poor outcome.
  
  
  
  A prospective descriptive study of 100 consecutively admitted children with TBM at Pham Ngoc Thach Hospital, Ho Chi Minh City. Cox and logistic regression were used to identify factors associated with risk of death and a combined endpoint of death or disability at treatment completion.
  
  
  
  The study enrolled from October 2009 to March 2011. Median age was 32.5 months; sex distribution was equal. Median duration of symptoms was 18.5 days and time from admission to treatment initiation was 11 days. Fifteen of 100 children died, 4 were lost to follow-up, and 27/81 (33 %) of survivors had intermediate or severe disability upon treatment completion. Microbiological confirmation of disease was made in 6 %. Baseline characteristics associated with death included convulsions (HR 3.46, 95CI 1.19-10.13, p = 0.02), decreased consciousness (HR 22.9, 95CI 3.01-174.3, p < 0.001), focal neurological deficits (HR 15.7, 95CI 1.67-2075, p = 0.01), Blantyre Coma Score (HR 3.75, 95CI 0.99-14.2, p < 0.001) and CSF protein, lactate and glucose levels. Neck stiffness, MRC grade (children aged >5 years) and hydrocephalus were also associated with the combined endpoint of death or disability.
  
  
  
  Tuberculous meningitis in Vietnamese children has significant mortality and morbidity. There is significant delay in diagnosis; interventions that increase the speed of diagnosis and treatment initiation are likely to improve outcomes.
authors.affiliation: Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam.|Pham Ngoc Thach Hospital, 120 Hung Vuong, Quan 5, Ho Chi Minh City, Vietnam.
authors.forename: Nguyen Duc
authors.initials: ND
authors.lastname: Bang
authors.affiliation: Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam.|Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, L3 5QA, Liverpool, UK.|Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Old Road campus, Roosevelt Drive, Oxford, UK.
authors.forename: Maxine
authors.initials: M
authors.lastname: Caws
authors.affiliation: Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam.
authors.forename: Thai Thanh
authors.initials: TT
authors.lastname: Truc
authors.affiliation: Pham Ngoc Thach Hospital, 120 Hung Vuong, Quan 5, Ho Chi Minh City, Vietnam.
authors.forename: Tran Ngoc
authors.initials: TN
authors.lastname: Duong
authors.affiliation: Pham Ngoc Thach Hospital, 120 Hung Vuong, Quan 5, Ho Chi Minh City, Vietnam.
authors.forename: Nguyen Huy
authors.initials: NH
authors.lastname: Dung
authors.affiliation: Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam.|Pham Ngoc Thach Hospital, 120 Hung Vuong, Quan 5, Ho Chi Minh City, Vietnam.
authors.forename: Dang Thi Minh
authors.initials: DT
authors.lastname: Ha
authors.affiliation: Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam.|Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Old Road campus, Roosevelt Drive, Oxford, UK.
authors.forename: Guy E
authors.initials: GE
authors.lastname: Thwaites
authors.affiliation: Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam.|Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Old Road campus, Roosevelt Drive, Oxford, UK.
authors.forename: Doortje
authors.initials: D
authors.lastname: Heemskerk
authors.affiliation: Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Old Road campus, Roosevelt Drive, Oxford, UK.|Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, 420/6 Ratchawithi Rd., Bangkok, Thailand.
authors.forename: Joel
authors.initials: J
authors.lastname: Tarning
authors.affiliation: Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam.|Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Old Road campus, Roosevelt Drive, Oxford, UK.
authors.forename: Laura
authors.initials: L
authors.lastname: Merson
authors.affiliation: Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam.|Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Old Road campus, Roosevelt Drive, Oxford, UK.
authors.forename: Pham
authors.initials: P
authors.lastname: Van Toi
authors.affiliation: Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam.|Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Old Road campus, Roosevelt Drive, Oxford, UK.
authors.forename: Jeremy J
authors.initials: JJ
authors.lastname: Farrar
authors.affiliation: Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam.|Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Old Road campus, Roosevelt Drive, Oxford, UK.
authors.forename: Marcel
authors.initials: M
authors.lastname: Wolbers
authors.affiliation: Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam.|Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Old Road campus, Roosevelt Drive, Oxford, UK.|Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, 420/6 Ratchawithi Rd., Bangkok, Thailand.
authors.forename: Thomas
authors.initials: T
authors.lastname: Pouplin
authors.affiliation: Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam. jday@oucru.org.|Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Old Road campus, Roosevelt Drive, Oxford, UK. jday@oucru.org.
authors.forename: Jeremy N
authors.initials: JN
authors.lastname: Day
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000382:microbiology; D007223:Infant; D007902:Length of Stay; D016015:Logistic Models; D059012:Lost to Follow-Up; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D013129:Spinal Puncture; D016896:Treatment Outcome; D014390:Tuberculosis, Meningeal / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality*; D014744:Vietnam
keywords: Children; Mycobacterium; Survival; Tuberculous meningitis; Vietnam