Tuberculous meningitis in the elderly

Area of Science:

• Neurology
• Infectious Diseases
• Geriatrics

Background:

• Tuberculosis (TB) disproportionately affects the elderly, yet tuberculous meningitis (TBM) in this demographic is understudied.
• Limited research exists on the specific clinical spectrum and outcomes of TBM in geriatric populations.

Purpose of the Study:

• To investigate the clinical characteristics, cerebrospinal fluid (CSF) findings, radiological features, and outcomes of TBM in elderly patients.
• To compare these aspects between elderly (≥60 years) and younger (18-59 years) adult TBM patients.

Main Methods:

• A prospective cohort study enrolled adult TBM patients at a tertiary care center in India.
• Older patients (≥60 years) were recruited from January 2019 to December 2020, and younger adults (18-59 years) from July 2019 to December 2019.

Main Results:

• Elderly patients more frequently presented with altered mental status and advanced disease but less commonly reported headache, vomiting, or fever.
• CSF analysis revealed less pronounced abnormalities in the elderly, with significantly lower median cell counts.
• While hydrocephalus and infarcts were common in both groups, tuberculomas were less frequent in the elderly. Survival rates were significantly lower in older patients (56.4% vs. 76.7%).

Conclusions:

• Geriatric TBM patients exhibit distinct clinical, CSF, and radiological profiles compared to younger adults.
• TBM in the elderly is associated with significantly worse survival rates, underscoring a critical unmet need in geriatric infectious disease management.