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Culture positive tuberculous meningitis: clinical indicators of poor prognosis
1Department of Neurology, Singapore General Hospital, Singapore. ek12@aol.com
Abstract:
Few studies have evaluated culture positive tuberculous meningitis (TBM) as a group. We evaluated certain clinical factors in culture positive TBM which could be associated with a poorer outcome. Out of 40 consecutive TBM patients seen over a period of 4 years in a tertiary referral hospital, 18 culture positive and non-human immunodeficiency virus (HIV) related cases were studied. The mean age was 37.9 +/- 14.9 years (range 9-63); five were males and 13 females. None had any associated active chronic medical illness. Patients (44.4%) started on antituberculous treatment within 24 h of admission. Treatment was initiated at a median time of 48 h upon admission in hospital. Univariate analysis revealed a significant correlation between hydrocephalus (P = 0.007) and poor morbidity and mortality. The other clinical factors were not statistically significant: age (P = 0.36): sex (P = 0.49); symptom duration (P = 0.69); BCG vaccination (P = 0.65); cerebral infarct (P = 0.63); extrameningeal spread (P = 1.00); steroids (P = 1.00); time to treatment (P = 0.94) and stage of disease (P = 0.11). Hydrocephalus was the only significant factor predisposing culture positive TBM patients to a poorer outcome. There was also a trend towards a poorer prognosis in those with advanced stage of the disease.
Insights
Hydrocephalus is a key predictor of poor outcomes in culture-positive tuberculous meningitis (TBM). This finding highlights the importance of identifying and managing hydrocephalus in TBM patients for improved prognosis.
Area of Science:
- Neurology
- Infectious Diseases
- Public Health
Background:
- Tuberculous meningitis (TBM) is a severe form of extrapulmonary tuberculosis.
- Few studies have specifically analyzed culture-positive TBM cases as a distinct group.
- Identifying prognostic factors in culture-positive TBM is crucial for patient management.
Purpose of the Study:
- To evaluate clinical factors associated with poorer outcomes in culture-positive tuberculous meningitis.
- To determine if specific clinical characteristics predict increased morbidity and mortality in these patients.
Main Methods:
- Retrospective analysis of 40 consecutive TBM patients over 4 years.
- Focus on 18 culture-positive, non-HIV-related cases.
- Univariate analysis of clinical factors including age, sex, symptom duration, hydrocephalus, cerebral infarct, extrameningeal spread, steroid use, time to treatment, and disease stage.
Main Results:
- Hydrocephalus was significantly correlated with poor morbidity and mortality (P = 0.007).
- Other evaluated factors (age, sex, symptom duration, BCG vaccination, cerebral infarct, extrameningeal spread, steroids, time to treatment, disease stage) were not statistically significant predictors of outcome.
- A trend towards poorer prognosis was observed in patients with advanced disease stage.
Conclusions:
- Hydrocephalus is the sole significant factor identified that predisposes culture-positive TBM patients to a poorer outcome.
- Early identification and management of hydrocephalus may be critical for improving outcomes in culture-positive TBM.