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Wang DM, Li QF, Zhu M, Wu GH, Li X, Xu YH, Zhong J, Luo J, Li YJ, Ying BW, Tao CM. Epidemiological, clinical characteristics and drug resistance situation of culture-confirmed children TBM in southwest of China: a 6-year retrospective study. BMC Infect Dis 2020; 20:318. [PMID: 32357835 PMCID: PMC7195785 DOI: 10.1186/s12879-020-05041-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 04/16/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Sichuan is a province located in southwestern China, which have a higher incidence of tuberculosis (TB). This study aimed to analyze the epidemiological and clinical characteristics, as well as drug resistance in culture-confirmed children with Tuberculosis meningitis (TBM) in Southwest of China. METHODS We performed a retrospective study on children (< 14 years old) with cerebrospinal fluid (CSF) culture-confirmed TBM between January 2013 and December 2018 at Public Health Clinical Center of Chengdu (PHCCC). Mycobacterium tuberculosis (MTB) drug sensitivity testing (DST) was performed using the MicroDST™ method. The age, gender, family history of tuberculosis, status of Bacillus Calmette-Guérin (BCG) vaccination, residential areas information, clinical, laboratory, and radiological features were recorded. Data were analyzed using SPSS Statistics Client 25.0, and the change in drug resistance rate was examined using the Cruskal-Wallis test. RESULTS Among 319 patients clinically diagnosed with TBM, 42 (13.2%) were Mycobacterial culture positive. Their median age was nine years, and the distribution was equal among female and male patients. Among 42 patients who were enrolled in the study, 1/42 (2.38%) passed away. Children with TBM were concentrated in the minority areas of western Sichuan, where 34/42 (81.0%) patients with TBM belonged to ethnic minorities, and only 2/42 (4.76%) received BCG vaccination in the past. Chest X-rays changes were observed in all patients. Fever and headache were the most common presenting symptom. Thirty-five (83.3%) patients suffered from neck stiffness, and 30/42 (71.4%) had high CSF pressure. DST results showed that the resistance rate was high; resistance to any anti-tuberculosis drug (ATD) was observed in 13 (31.0%) patient isolates, while multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) were found in 2 (4.8%) and 1 (2.4%) patients, respectively. CONCLUSIONS TBM among children in Southwest China was mainly concentrated in the minority areas of western Sichuan and more than 95% of patients did not receive BCG vaccination at birth. The most common symptoms were fever, headache, and neck stiffness and all patients had positive chest X-ray findings. In addition, high rates of drug resistance were found.
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Affiliation(s)
- Dong-Mei Wang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, 610041 China
- Department of Clinical Laboratory, Public Health Clinical Center of Chengdu, 377 Jingming Road, Jinjiang District, Chengdu, 610061 Sichuan China
| | - Qing-Feng Li
- Department of Clinical Laboratory, Public Health Clinical Center of Chengdu, 377 Jingming Road, Jinjiang District, Chengdu, 610061 Sichuan China
| | - Ma Zhu
- Department of Clinical Laboratory, Public Health Clinical Center of Chengdu, 377 Jingming Road, Jinjiang District, Chengdu, 610061 Sichuan China
| | - Gui-Hui Wu
- Department of Clinical Laboratory, Public Health Clinical Center of Chengdu, 377 Jingming Road, Jinjiang District, Chengdu, 610061 Sichuan China
| | - Xi Li
- Department of Clinical Laboratory, Public Health Clinical Center of Chengdu, 377 Jingming Road, Jinjiang District, Chengdu, 610061 Sichuan China
| | - Yuan-Hong Xu
- Department of Clinical Laboratory, Public Health Clinical Center of Chengdu, 377 Jingming Road, Jinjiang District, Chengdu, 610061 Sichuan China
| | - Jing Zhong
- Department of Clinical Laboratory, Public Health Clinical Center of Chengdu, 377 Jingming Road, Jinjiang District, Chengdu, 610061 Sichuan China
| | - Jia Luo
- Department of Clinical Laboratory, Public Health Clinical Center of Chengdu, 377 Jingming Road, Jinjiang District, Chengdu, 610061 Sichuan China
| | - Ying-Jie Li
- Department of Clinical Laboratory, Public Health Clinical Center of Chengdu, 377 Jingming Road, Jinjiang District, Chengdu, 610061 Sichuan China
| | - Bin-Wu Ying
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, 610041 China
| | - Chuan-Min Tao
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, 610041 China
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