scholarly journals Temporal changes in the incidence and pattern of central nervous system relapses in children with acute lymphoblastic leukaemia treated on four consecutive Medical Research Council trials, 1985–2001

Leukemia ◽  
2009 ◽  
Vol 24 (2) ◽  
pp. 450-459 ◽  
Author(s):  
S Krishnan ◽  
R Wade ◽  
A V Moorman ◽  
C Mitchell ◽  
S E Kinsey ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Acute Lymphoblastic Leukaemia ◽  
Medical Research ◽  
Lymphoblastic Leukaemia ◽  
Research Council ◽  
Medical Research Council ◽  
Temporal Changes

Outcomes of Pediatric Central Nervous System Tuberculosis in California, 1993–2011

2018 ◽  
Vol 8 (5) ◽  
pp. 439-449 ◽  
Author(s):  
Alexandra Duque-Silva ◽  
Varsha Hampole ◽  
Yi-Ning Cheng ◽  
Jennifer Flood ◽  
Pennan M Barry
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Medical Research ◽  
Research Council ◽  
Pediatric Patients ◽  
Medical Research Council ◽  
Stage I ◽  
Poor Outcome ◽  
Increased Risk ◽  
Modifiable Factors

Abstract Background Our goal was to describe the characteristics and posttreatment outcomes of pediatric patients with central nervous system (CNS) tuberculosis (TB) and to identify factors associated with poor outcome. Methods We included children aged 0 to 18 years with CNS TB reported to the California TB registry between 1993 and 2011. Demographics, clinical characteristics, severity of disease at presentation (Modified Medical Research Council stage I, II, or III [III is most severe]), treatment, and outcomes during the year after treatment completion were abstracted systematically from the medical and public health records. Patient outcomes were categorized as good or poor on the basis of disability in hearing, vision, language, ambulation, and development and other neurologic deficits. Results Among 151 pediatric CNS TB cases reported between 1993 and 2011 in California for which records were available, 92 (61%) cases included sufficient information to determine outcome. Overall, 55 (60%) children had a poor outcome. After we adjusted for age (0 to 4 years), children with stage III severity (vs I or II; prevalence rate ratio [PRR], 1.4 [95% confidence interval (CI), 1.1–1.9]), a protein concentration of >100 mg/dL on initial lumbar puncture (PRR, 1.2 [95% CI, 1.03–1.4]), or infarct on neuroimaging (PRR, 1.2 [95% CI, 1.04–1.3]) were at increased risk for a poor outcome. In multivariate analysis, an age of 0 to 4 years (vs >4 years; PRR, 1.4 [95% CI, 1.2–1.7]) and a stage II or III Modified Medical Research Council score (vs stage I; PRR, 1.2 [95% CI, 1.03–1.5]) remained significantly associated with poor outcome. Conclusions Pediatric patients with CNS TB in California are left with high rates of disabling clinical sequelae after treatment. The identification of modifiable factors is critical for improving outcomes.

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