Definite (microbiologically confirmed) tuberculous meningitis: predictors and prognostic impact

Area of Science:

• Infectious Diseases
• Neurology
• Microbiology

Background:

• Microbiological confirmation of tuberculous meningitis (TBM) is challenging, with only one-third of patients achieving it.
• Identifying predictors for microbiological confirmation is crucial for timely diagnosis and treatment.

Purpose of the Study:

• To identify epidemiological, clinical, cerebrospinal fluid (CSF), and imaging parameters associated with microbiologically confirmed TBM.
• To determine factors predicting poor outcomes in TBM patients.

Main Methods:

• A prospective observational study enrolled 118 patients with suspected TBM.
• Patients underwent clinical evaluation, CSF analysis (microscopy, culture, PCR), and neuroimaging.
• Treatment included anti-tuberculosis drugs and corticosteroids, with a 6-month follow-up.

Main Results:

• Of 118 TBM cases, 43 (36%) were definite (microbiologically confirmed).
• Definite TBM was associated with modified Barthel index ≤12, CSF cell count >100/mm³, and basal exudates on imaging.
• Poor outcome was linked to Stage III TBM, low modified Barthel index, and positive TBM PCR.

Conclusions:

• Severe disability, elevated CSF cell counts, and basal exudates indicate microbiologically confirmed TBM.
• Microbiologically confirmed TBM is associated with a poorer prognosis.