Trend of Tuberculous Meningitis since 1970

Park, Jeong A; Oh, Chang Weon; Kim, Kyoung Sim; Kim, Yong Wook; Kim, Ki Bok

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.
CONCLUSIONS
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.