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All Journal Paediatrica Indonesiana
Hardiono D. Pusponegoro
Department of Child Health, University of Indonesia Medical School/Dr. Cipto Mangunkusumo Hospital, Jakarta
Health Professions Medicine & Pharmacology

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Outcomes of tuberculous meningitis in children: a case review study Yazid Dimyati; Anna Tjandradjani; Irawan Mangunatmadja; Dwi Putro Widodo; Hardiono D. Pusponegoro
Paediatrica Indonesiana Vol 51 No 5 (2011): September 2011
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi51.5.2011.288-93

Abstract

Background Tuberculous meningitis is a severe extrapulmonary complication of tuberculosis, with high morbidity and mortality rates.Objective To assess the relationship between presenting clinical characteristics and outcomes of pediatric tuberculous meningitis.Methods We present a case review study of all children diagnosed with tuberculous meningitis in Cipto Mangunkusumo Hospital, Jakarta between January 1998 and December 2004. We compared demographic, clinical, and diagnostic characteristics to clinical outcomes.Results We included 43 patients. Common characteristics on admission were young age (mean 3.2 years), stage II and III tuberculous meningitis (91%), and neurological symptoms existing for more than 1 week, including convulsions (52%), unconsciousness (23%), meningeal irritation (56%), and cranial nerve palsy (67%). A common feature of tuberculous meningitis on computed tomography scan of the brain was hydrocephalus in 19/24 cases. Clinical outcomes were neurological sequelae (88%) and death (12%). Factors associated with poor outcome in univariate analyses were young age, as well as stage II and III tuberculous meningitis.Conclusions Tuberculous meningitis starts with nonspecific symptoms and is often only diagnosed when brain damage has already occurred. Outcome is directly associated with age and the stage of tuberculous meningitis. Earlier diagnosis may significantly improve outcomes. [Paediatr Indones. 2011;51:288-93].
Clinical features and survival pattern of central nervous system leukemia in children with acute lymphoblastic leukemia Hardiono D. Pusponegoro; Moeslichan M. Z.; Risma K. Kaban; Rulina Suradi; Endang Windiastuti
Paediatrica Indonesiana Vol 41 No 9-10 (2001): September 2001
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (300.834 KB) | DOI: 10.14238/pi41.5.2001.247-52

Abstract

Infiltration of leukemic cells into the central nervous system (CNS) is one of the causes of neurological disorders in patients with acute lymphoblastic leukemia (ALL) that worsen the prognosis. This retrospective cohort study aimed to review the clinical manifestations of children with CNS leukemia, their survival pattern and the role of early CNS leukemial. The survival curve was developed by Kaplan-Meier method, while the comparison of survival curves was done with log-rank test. Among 128 new ALL patients, 23 (18.0%) patients suffered from CNS leukemia, while 13 (10.2%) suffered from early CNS leukemia and 10 (7.8%) suffered from relapsing CNS leukemia. CNS leukemia was more common in male, in those aged less than 2 years, in those with white blood cell (WBC) count above 50,000/ìl, and in patients type FAB-L2 ALL. The clinical manifestations most commonly found were decrease of consciousness (61%), vomiting (48%), cranial nerve palsy (44%), seizures (39%), and headache (26%). Relapsing CNS leukemia was more common in high risk (12.5%) compared with standard risk leukemia (5.7%). Patients with early CNS leukemia had a lower survival rate than those without early CNS leukemia (p = 0.0005). The percentage of patients with early CNS leukemia surviving up to 3 years was 26%. We conclude that early CNS leukemia could cause low survival ALL patients.
Co-Authors Anna Tjandradjani Dwi Putro Widodo Endang Windiastuti Irawan Mangunatmadja Moeslichan M. Z. Risma K. Kaban Rulina Suradi Yazid Dimyati