Clinical characteristics of childhood tuberculous meningitis and risk factors for severe neurological sequelae disaggregated by age group

Childhood tuberculous meningitis (TBM) often leads to death or severe neurological sequelae. We aimed to evaluate clinical characteristics of childhood TBM and identify risk factors for severe neurological sequelae. A retrospective analysis was conducted on the consecutive clinical data of inpatient with TBM under 15 years admitted to Shanghai Public Health Clinical Center from 2013 to 2024. Patients were divided into two age groups: <5 yearsand 5–14 years. Demographic characteristics, clinical symptoms, laboratory tests, imaging findings, treatment regimens, and outcomes at 12 months post-treatment were compared between the two groups. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for severe neurological sequelae. This study enrolled 107 children, 61 under 5 years (57.0%), and 46 were 5–14 years (43.0%). The < 5 years group had a higher proportion of TBM stage III cases (29.5% vs. 2.2%, p <0.001) than the 5–14 years group. The < 5 years group had higher proportions of concurrent pulmonary tuberculosis, altered consciousness, signs of increased intracranial pressure, hydrocephalus, and ventricular enlargement compared to the 5–14 years group. At the same time, the Glasgow Coma Scale score was significantly lower. At 12 months post-treatment, the < 5 years group showed significantly higher rates of unfavourable prognosis and drug-induced liver injury. The incidence of severe neurological sequelae was 20.6% (22/107). Univariate regression revealed that TBM stage III, altered consciousness, coma, signs of upper motor neuron damage, hydrocephalus, and external ventricular drainage were associated with severe neurological sequelae. Multivariate regression identified coma as an independent risk factor for severe neurological sequelae in pediatric TBM (aOR = 6.17, 95% CI: 1.94–19.56, P = 0.002). This study demonstrates that younger children (< 5 years) with TBM present with more severe conditions, higher complication rates, and poorer prognoses. Coma is an independent risk factor for severe neurological sequelae. In clinical practice, early recognition of TBM in younger children and aggressive comprehensive treatment for comatose patients should be emphasized to facilitate the development of early individualized intervention strategies and optimize treatment outcomes for this population.