1921
Volume 101, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

Most deaths in tuberculous meningitis occur in the early part of the illness. We assessed the determinants of early deaths, occurring within 2 months of intensive therapy. We prospectively included consecutive newly diagnosed adults with HIV-negative tuberculous meningitis. Patients were given WHO-recommended antituberculosis treatment and were followed up for 9 months. We enrolled 152 patients. A total of 26 deaths were recorded during 2 months. The logistic regression analysis revealed that papilledema ( = 0.029, odds ratio (OR) = 4.8 [1.2–19.8]), increasing age ( = 0.001, OR = 1.07 [1.03–1.1]), stage-III disease (Glasgow coma scale score ≤ 10; = 0.01, OR = 4.2 [1.4–12.3]), and hydrocephalus ( = 0.003, OR = 8.4 [2.1–33.6]) were independently associated with death. In addition, cerebral infarcts ( = 0.012, OR = 5.6 [1.5–21.3]), paraparesis ( = 0.004, OR = 8.8 [2.02–38.1]), and age ( = 0.005, OR = 1.05 [1.02–1.09]) were associated with poor functional outcome. In conclusion, disease severity predicts early deaths in tuberculous meningitis.

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References

  1. Cresswell FV et al., 2018. Can improved diagnostics reduce mortality from tuberculous meningitis? Findings from a 6.5-year cohort in Uganda. Wellcome Open Res 3: 64.
    [Google Scholar]
  2. Graham SM, Donald PR, 2014. Death and disability: the outcomes of tuberculous meningitis. Lancet Infect Dis 14: 902904.
    [Google Scholar]
  3. Thao LTP et al., 2018. Prognostic models for 9-month mortality in tuberculous meningitis. Clin Infect Dis 66: 523532.
    [Google Scholar]
  4. Chiang SS, Khan FA, Milstein MB, Tolman AW, Benedetti A, Starke JR, Becerra MC, 2014. Treatment outcomes of childhood tuberculous meningitis: a systematic review and meta-analysis. Lancet Infect Dis 14: 947957.
    [Google Scholar]
  5. Wilkinson RJ et al., 2017. Tuberculous meningitis. Nat Rev Neurol 13: 581598.
    [Google Scholar]
  6. Soria J, Metcalf T, Mori N, Newby RE, Montano SM, Huaroto L, Ticona E, Zunt JR, 2019. Mortality in hospitalized patients with tuberculous meningitis. BMC Infect Dis 19: 9.
    [Google Scholar]
  7. Iype T, George LE, Cherian A, Kumar A, Ajitha BK, Chandy S, Kumar KV, 2012. In-hospital mortality of intermittent vs daily antitubercular regimen in patients with meningeal tuberculosis—a retrospective study. Indian J Tuberc 59: 611.
    [Google Scholar]
  8. George EL, Iype T, Cherian A, Chandy S, Kumar A, Balakrishnan A, Vijayakumar K, 2012. Predictors of mortality in patients with meningeal tuberculosis. Neurol India 60: 1822.
    [Google Scholar]
  9. Marais S, Thwaites G, Schoeman JF, Török ME, Misra UK, Prasad K, Donald PR, Wilkinson RJ, Marais BJ, 2010. Tuberculous meningitis: a uniform case definition for use in clinical research. Lancet Infect Dis 10: 803812.
    [Google Scholar]
  10. Thwaites GE et al., 2004. Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults. N Engl J Med 351: 17411751.
    [Google Scholar]
  11. World Health Organization, 2017. Treatment of Tuberculosis Guidelines for Treatment of Drug-Susceptible Tuberculosis and Patient Care 2017 Update. Available at: https://www.who.int/tb/publications/2017/dstb_guidance_2017/en/. Accessed January 26, 2019.
    [Google Scholar]
  12. Mahoney FI, Barthel DW, 1965. Functional evaluation: the Barthel index. Md State Med J 14: 6165.
    [Google Scholar]
  13. Davis AG, Rohlwink UK, Proust A, Figaji AA, Wilkinson RJ, 2019. The pathogenesis of tuberculous meningitis. J Leukoc Biol 105: 267280.
    [Google Scholar]
  14. Panackal AA, Williamson KC, van de Beek D, Boulware DR, Williamson PR, 2016. Fighting the monster: applying the host damage framework to human central nervous system infections. MBio 7: e01906e01915.
    [Google Scholar]
  15. Gupta R, Kushwaha S, Thakur R, Jalan N, Rawat P, Gupta P, Manchanda V, 2017. Predictors of adverse outcome in patients of tuberculous meningitis in a multi-centric study from India. Indian J Tuberc 64: 296301.
    [Google Scholar]
  16. Thuong NTT, Vinh DN, Hai HT, Thu DDA, Nhat LTH, Heemskerk D, Bang ND, Caws M, Mai NTH, Thwaites GE, 2019. Pre-treatment cerebrospinal fluid bacterial load correlates with inflammatory response and predicts neurological events during tuberculous meningitis treatment. J Infect Dis 219: 986995.
    [Google Scholar]
  17. Ruslami R, Ganiem AR, Dian S, Apriani L, Achmad TH, van der Ven AJ, Borm G, Aarnoutse RE, van Crevel R, 2013. Intensified regimen containing rifampicin and moxifloxacin for tuberculous meningitis: an open-label, randomised controlledphase 2 trial. Lancet Infect Dis 13: 2735.
    [Google Scholar]
  18. Heemskerk AD et al., 2016. Intensified antituberculosis therapy in adults with tuberculous meningitis. N Engl J Med 374: 124134.
    [Google Scholar]
  19. Misra UK, Kalita J, Nair PP, 2010. Role of aspirin in tuberculous meningitis: a randomized open label placebo controlled trial. J Neurol Sci 293: 1217.
    [Google Scholar]
  20. Rizvi I, Garg RK, Malhotra HS, Kumar N, Sharma E, Srivastava C, Uniyal R, 2017. Ventriculo-peritoneal shunt surgery for tuberculous meningitis: a systematic review. J Neurol Sci 375: 255263.
    [Google Scholar]
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  • Received : 31 Jan 2019
  • Accepted : 21 May 2019
  • Published online : 24 Jun 2019
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