Namukuta Victoria E, Smith Mariette, Bester Danite, van Niekerk Magriet, Solomons Regan, van Toorn Ronald, Schaaf Hendrik Simon, Seddon James A, Rabie Helena, Davies Mary-Ann, Hesseling Anneke C, du Preez Karen
Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town 7505, South Africa.
Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town 8000, South Africa.
Trop Med Infect Dis. 2025 May 7;10(5):127. doi: 10.3390/tropicalmed10050127.
Tuberculous meningitis (TBM) is a very severe form of childhood tuberculosis (TB), requiring hospitalisation for diagnosis. We investigated trends in admission, disease spectrum, outcomes, and healthcare system factors in children with TBM managed at a tertiary referral hospital in Cape Town, South Africa. We conducted a retrospective cohort study of children (<13 years) with TBM admitted from 2017 to 2021. An innovative surveillance algorithm was used to identify all possible TBM episodes using integrated electronic health data. Episodes were clinically verified and data were extracted using medical records. A total of 263 children (median age 2.2 years; IQR: 1.1-5.1), 17 (6.5%) living with HIV were admitted with TBM during 2017 to 2021. There was a significant reduction in TBM admissions during the COVID-19 pandemic (IRR: 0.57, 95% CI:0.39-0.84), particularly in children < 2 years (IRR: 0.31, 95% CI: 0.15-0.62). BCG vaccination was documented in 137/263 (52.1%) and 10/87 (11.5%) eligible children who initiated TB preventive therapy. During the pandemic, children with TBM were significantly more likely to be living with HIV (aOR: 4.01, 95% CI: 1.39-11.62). COVID-19 was associated with a significant reduction in the number of young children admitted with TBM. Many missed opportunities to prevent TBM were identified regardless of COVID-19. Paediatric TBM surveillance is a useful marker to monitor epidemiological trends.
结核性脑膜炎（TBM）是儿童结核病（TB）的一种非常严重的形式，需要住院进行诊断。我们调查了在南非开普敦一家三级转诊医院接受治疗的TBM患儿的入院趋势、疾病谱、结局以及医疗系统因素。我们对2017年至2021年期间入院的＜13岁TBM患儿进行了一项回顾性队列研究。使用一种创新的监测算法，通过整合电子健康数据来识别所有可能的TBM病例。病例经过临床核实，并使用病历提取数据。2017年至2021年期间，共有263名儿童（中位年龄2.2岁；四分位间距：1.1 - 5.1）因TBM入院，其中17名（6.5%）为HIV感染者。在新冠疫情期间，TBM入院人数显著减少（发病率比：0.57，95%置信区间：0.39 - 0.84），尤其是＜2岁的儿童（发病率比：0.31，95%置信区间：0.15 - 0.62）。在开始结核病预防性治疗的符合条件的儿童中，137/263（52.1%）和10/87（11.5%）有卡介苗接种记录。疫情期间，TBM患儿感染HIV的可能性显著更高（调整后的比值比：4.01，95%置信区间：1.39 - 11.62）。新冠疫情与TBM入院的幼儿数量显著减少有关。无论是否有新冠疫情，都发现了许多预防TBM的错失机会。儿科TBM监测是监测流行病学趋势的一个有用指标。
