Tuberculous meningitis in adults: Review of 61 cases

• Published in: Infection 2003-12, Vol.31 (6), p.387-391
• Main Authors: SÜTLAS, P. N, ÜNAL, A, FORTA, H, SENOL, S, KIRBAS, D
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age Distribution; Aged; Antitubercular Agents - therapeutic use; Bacterial diseases; Bacterial diseases of the nervous system. Bacterial myositis; Biological and medical sciences; Confidence Intervals; Corticoids; Developing countries; Female; Human bacterial diseases; Humans; Incidence; Infectious diseases; LDCs; Lymphocytes; Male; Medical sciences; Middle Aged; Mortality; Mycobacterium tuberculosis; Mycobacterium tuberculosis - isolation & purification; Odds Ratio; Probability; Public health; Retrospective Studies; Risk Assessment; Severity of Illness Index; Sex Distribution; Statistical analysis; Survival Rate; Tomography, X-Ray Computed; Tuberculosis; Tuberculosis and atypical mycobacterial infections; Tuberculosis, Meningeal - diagnosis; Tuberculosis, Meningeal - drug therapy; Tuberculosis, Meningeal - epidemiology; Turkey - epidemiology
• ISSN: 0300-8126; 1439-0973
• DOI: 10.1007/s15010-003-3179-1

Tuberculosis is still a major cause of serious illness in developing countries. The objective of this study was to assess the clinical, laboratory, radiological and prognostic features of tuberculous meningitis (TBM) in immuncompetent adult patients. Sixty-one patients with confirmed or presumed TBM seen over a 12-year period at the Neurology Department of Bakirköy Research and Training Hospital for Psychiatric and Neurological Disease, Istanbul, Turkey, were analyzed retrospectively. Patients were grouped according to the severity of meningitis on admission (stages I, II and III). They were also divided into two groups according to the presence of paradoxical response (progressive increase of lymphocytes or increase of polymorphonuclear cells instead of lymphocytes) in CSF samples. A combination of five antituberculosis drugs was used in the 1st month of treatment. Patients received antituberculosis therapy for at least 12 months. The outcome of the patients was defined on the basis of the 12-month Barthel index (BI) score (BI < 12 poor; BI >/= 12 good). For statistical analysis death was included in the poor outcome group. Paradoxical response in CSF findings was seen in 20 patients. There was no statistically significant difference between the outcome of the patients with and without CSF paradoxical response; however, new tuberculomas developed more frequently in the first group (p < 0.05). The overall mortality was 27.8%. Stage of disease was found to be independently associated with the 12-month outcome (OR 7.2; 95% CI 1.7-30.3, p = 0.007). In developing countries such as Turkey, tuberculosis is still an important public health issue. Early suspicion and appropriate long-term antituberculosis therapy together with corticosteroids may reduce mortality and morbidity in TBM patients.