Meningeal tuberculosis: high long-term mortality despite standard therapy

The long-term outcomes of patients with tuberculous meningitis treated with modern chemotherapy are poorly defined. We conducted this retrospective case-control study to determine the long-term survival in patients with proven tuberculous meningitis treated by directly observed therapy in the state of Texas. The patients had been diagnosed and treated for tuberculous meningitis between 2000 and 2005 in the state of Texas. Cases were patients with microbiologically proven tuberculous meningitis; controls were patients in whom Mycobacterium tuberculosis could not be isolated but met the Centers for Diseases Control and Prevention (CDC) criteria for non-proven tuberculous meningitis. There were 135 cases and 75 controls, with average observation periods of 3.76 +/- 2.63 years and 4.51 +/- 2.09 years, respectively. At the end of the observation period, 39.76% of cases were still alive compared to 85.07% of controls. The long-term outlook in patients with proven tuberculous meningitis adequately treated with current standard tuberculous therapy is bleak. A re-examination of treatment strategies is urgently needed.