Objective To systematically review the risk factors for death in children with tuberculous meningitis (TBM). Methods The CNKI, VIP, WanFang Data, CBM, Cochrane Library, Web of Science, PubMed, EMbase and CINAHL databases were electronically searched to collect studies on the risk factors for death in children with TBM from inception to October 2022. Two reviewers independently screened the literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.3 software. Results A total of 15 studies involving 2 597 patients were included. The results of meta-analysis showed that male (OR=2.41, 95%CI 1.61 to 3.61, P<0.01), no history of BCG vaccination (OR=3.74, 95%CI 1.96 to 7.12, P<0.01), TBM stage (stage Ⅲ) (OR=2.04, 95%CI 1.26 to 3.28, P<0.01), HIV infection (OR=3.28, 95%CI 1.20 to 8.93, P=0.02), convulsion (OR=3.61, 95%CI 3.31 to 3.94, P<0.01), disturbance of consciousness (OR=3.58, 95%CI 2.40 to 5.34, P<0.01), cerebrospinal fluid protein concentration increased (OR=1.87, 95%CI 1.39 to 2.51, P<0.01), hydrocephalus (OR=2.44, 95%CI 1.60 to 3.71, P<0.01) and short hospitalization (OR=2.89, 95%CI 2.05 to 4.06, P<0.01) were risk factors for death in children with TBM. Under 5 years old, negative PPD skin test, positive meningeal irritation sign, malnutrition and history of contact with TB may not be associated with the death of TBM in children. Conclusion Male, no history of BCG vaccination, TBM stage (stage Ⅲ), HIV infection, convulsions, disturbance of consciousness, cerebrospinal fluid protein concentration increased, hydrocephalus and short hospitalization are risk factors for death in children with TBM. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
Objective To investigate the clinical manifestations,diagnosis and treatment of extensively drug-resistant tuberculosis (XDR-TB)meningitis. Methods One case of primary tuberculousis meningitis infected with multidrug-resistant mycobacteria was analyzed retrospectively.Relevant literatures were also reviewed by retrieving information through Wanfang Database and Pubmed using key words "multiple drug resistant tuberculosis meningitis","MDR tuberculosis meningitis","multiple drug resistant TBM","mul-drug resistant tuberculous meningitis","extensively drug resistant tuberculosis meningitis","XDR TBM","extensively drug resistant TBM" both in Chinese and English. Results A 24-year-old male patient,complained of headache,vomiting for 5 days,aggravated with mental abnormalities for 10 hours,with no history of pulmonary tuberculosis,was hospitalized in the Affiliated Hospital of Zunyi Medical College.The chest plain film was normal.Craniocerebral CT scan showed mild-hydrocephalus and cisterna ambiens stenosis.The patient died after undergoing anti-TB treatments with isoniazid(INH)0.3g iv qd,INH 0.3g po qd,rifampicin(RFP)0.45g qd,pyrazinamide(PZA)1.5g qd,ethambutol(EMB)0.75g qd,and dexamethasone(DEX)15mg qd.He was diagnosed as XDR-TB meningitis(as drug-resistant to isoniazid,rifampicin,streptomycin,ciprofloxacin,paminosalicylic acid,kanamycin,and protionamide ).Mycobacteria tuberculosis was isolated from his cerebrospinal fluid after 3 months.Five cases in 4 literatures were retrieved through Wanfang database and Pubmed among which 2 cases were initial treated,3 cases was unknown about initial treatment or re-treatment. Conclusions XDR-TB meningitis is rare in clinical practice with serious condition,rapid progress and high mortality rate.It is necessary to acquire drug susceptibility test results as soon as possible and adjust treatments according different conditions.A molecular drug susceptibility test may be helpful in the future.
ObjectiveTo compare the clinical efficacy of video-assisted thoracoscopy and thoracotomy for the treatment of encapsulated tuberculous pleurisy. MethodsWe retrospectively analyzed the clinical data of 99 patients who had underwent surgery for encapsulated tuberculous pleurisy within 3 months of disease onset in our hospital from January through December 2013. Based on the surgical mode, patients were assigned to a video-assisted thoracoscopy group, including 49 patients (35 males and 14 females, a mean age of 26.78±9.36 years), to receive video-assisted thoracoscopic pleurectomy; or a thoracotomy group, including 50 patients (31 males and 19 females, a mean age of 31.84±11.08 years), to receive conventional thoracotomic pleurectomy. The first 43 patients in the video-assisted thoracoscopy group received thoracic catheter drainage, with the drainage volume of 659.08±969.29 ml; the first 48 patients in the thoracotomy group received thoracic catheter drainage, with the drainage volume of 919.03±129.97 ml. The clinical effects were compared between the two groups. ResultsAll the patients in the video-assisted thoracoscopy group completed thoracoscopy without conversion to thoracotomy. The surgery duration and postoperative intubation time were shorter in the video-assisted thoracoscopy group than those in the thoracotomy group (surgery duration:103.00±53.04 min vs. 127.06±51.60 min, P<0.01; postoperative intubation time 3.02±0.83 d vs. 3.94±1.25 d, P<0.01). At the end of 6 months of follow-up, the forced expiratory volume in one second (FEV1>) was 2.83±0.64 L in the thoracos-copy group and 2.25±0.64 L in the thoracotomy group (P<0.01); forced vital capacity (FVC) was 3.02±0.72 L in the thora-coscopy group and 2.57±0.79 L in the thoracotomy group (P<0.05); and maximal voluntary ventilation (MVV) was 93.90± 15.86 L in the thoracoscopy group and 80.34±17.06 L in the thoracotomy group (P<0.01). ConclusionThoracoscopic surgery is feasible for patients with encapsulated pleurisy within 3 months of onset. Furthermore video-assisted thoraco-scopy will be superior to thoracotomy.
ObjectiveTo analyze the curative effect and prognosis of drug resistant tuberculosis meningitis (TBM). MethodsRetrospective analysis was carried out on the clinical data of thirty-two cases of drug resistant tuberculous meningitis patients hospitalized from January 2010 to December 2015. And the prognosis of the patients was evaluated by meliorated Rankin Scale (mRS). ResultsThirty-one cases (96.9%) were improved in 32 patients with drug resistant TBM, and 1 case (3.1%) was ineffective. After treatment, one patient had hormone-related glaucoma and osteoporosis, and one patient had drug Cushing syndrome. Twenty-seven patients (84.4%) had an mRS score equal to or less than 2 points. ConclusionDrug resistant TBM is difficult to diagnose in the early stage, and the curative effect is satisfying with active anti-tuberculosis treatment.
ObjectivesTo evaluate the clinical value of laparoscopic exploration in the diagnosis of tuberculous peritonitis by meta-analysis.MethodsThe Cochrane Library, PubMed, Web of Science, WanFang Data, CNKI and VIP databases were electronically searched to collect relevant studies on the diagnostic value of laparoscopic exploration in diagnosing tuberculous peritonitis from January 1st, 1990 to April 1st, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. The Rveman 5.3, Meta-DiSc 1.4 and Stata SE15 software were used for statistical analysis and the receiver operating characteristic curve (SROC) was drawn.ResultsA total of 10 studies involving 1098 patients were included. The results of meta-analysis showed that the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnosis odds ratio and area under the curve of SROC were 0.98 (95%CI 0.96 to 0.98), 0.85 (95%CI 0.78 to 0.91), 4.78 (95%CI 1.98 to 11.54), 0.06 (95%CI 0.03 to 0.12), 111.40 (95%CI 36.55 to 339.58) and 0.971 1, respectively and the Q* was 0.9216.ConclusionsThe existing evidence shows that laparoscopic exploration has higher sensitivity and specificity in the diagnosis of tuberculous peritonitis. Laparoscopic exploration can be used as a diagnosis and treatment tool for patients with tuberculous peritonitis in case the laboratory test cannot determine the origin. Due to the limited quality and quantity of included studies, the above results should be validated by more studies.
Objective To investigate the postoperative treatment of pleuropneumonectomy for tuberculosis destroyed lung in ICU, in order to improve the therapeutical efficacy for these patients. Methods Clinical data of 52 patients who suffered from tuberculosis destroyed lung and underwent pleuropneumonectomy from June 2008 to June 2010 were analyzed retrospectively. All of subjects received routine treatment in ICU after the operation. Meanwhile，appropriate targeting treatments were applied including diagnosis and treatment of postoperative bleeding; application of fiberbronchoscope to aspirate the sputum after the operation,sequential non-invasive ventilation after the invasive ventilation for acute respiratory failure after operation ,etc.Results A total of 52 patients received the pleuropneumonectomy operation. Bleeding occurred in 11 cases after operation and stopped after the integrated therapy. 8 patients suffered from acute respiratory failure and attenuated after sequential ventilation. No patients died for postoperative bleeding or acute respiratory failure. Conclusions Patients who suffered from tuberculosis destroyed lung and received pleuropneumonectomy with postoperative bleeding and acute respiratory failure have a good prognosis after appropriate postoperative treatment in ICU.
目的:分析结核性脑膜炎的临床及治疗中影响预后的因素。方法:回顾分析10 年来我院收治的68 例结核性脑膜炎患者的临床及实验室资料。结果:59 例患者痊愈,5 例患者遗留肢体后遗症,4 例患者死亡。结论:治疗结核性脑膜炎过程中积极区分引起低钠血症的原因及鉴别药物热与类赫氏反应并给以合理治疗和对中重度和治疗效果不佳的结核性脑膜炎适时的鞘内注药可改善患者的预后。患者的体质同预后有关。