Epidemiological, Clinical characteristics and Drug resistance situation of Culture-confirmed Children TBM in Southwest of China: A 6-Year Retrospective Study

Abstract Background: There are little data on the disease in children. This study aimed to analyze the epidemiological, clinical characteristics and drug resistance situation of culture-confirmed children TBM in Southwest of China，and hope this study will provide some recommendations to readers in clinical or related fields. Methods: We performed a retrospective study including children <14 years of age with cerebrospinal fluid (CSF) culture-confirmed TBM between January 2013 and December 2018 at Public Health Clinical Center of Chengdu (PHCCC). Nontuberculosis Mycobacteria (NTM) were excluded. Mycobacterium tuberculosis (MTB) drug sensitivity testing (DST) was performed using the MicroDSTTM 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 19.0, and the change in drug resistance rate was analyzed using the chi-square (2) test. Results: From 3467 probable TBM patients recruited, 295 cases were Mycobacterial culture-positive, the positive rate of 8.5 per 100 patients, included 253 adults and 42 children. We included all the 42 children <14 years of age for this study, the median age was 9 years, sex distribution was equal, of which 1/42 (2.38%) died. The geographical distribution of children's TBM in southwest of China is mainly concentrated in the minority areas of western Sichuan. Thirty-four (81.0%) children TBM patients is the population of China's ethnic minorities, only 2/42 (4.76%) had BCG vaccination histories. All the 42 patients had varying degrees of Chest X-rays changes and 18/42(42.9%) merger of extracranial TB. Fever and headache are the most common presenting symptom. Thirty-five (83.3%) with neck stiffness and 30/42(71.4%) with high CSF pressure. DST results showed that the resistance rate was high, to any anti-tuberculosis drug (ATD) resistance was 18 (42.9%), to multidrug-resistant tuberculosis (MDR-TB) and pre-XDR rate were 1 (2.4%) respectively. Conclusions: TBM in Children in Southwest China were mainly concentrated in the minority areas of western Sichuan, presents with nonspecific clinical features and all with positive chest X-ray findings. High rates of drug resistance were founded. More than 95% of patients were lack of BCG vaccination at birth.