Clinical Profile, Outcomes, and Predictors of Outcomes in Patients with Tuberculosis with Arachnoiditis

Tuberculosis (TB) remains a leading global cause of infectious disease-related mortality. This study aimed to investigate the clinical characteristics, outcomes, and prognostic factors in patients diagnosed with tuberculous arachnoiditis, a serious complication of TB affecting the spinal cord and nerve roots.

This is a retrospective analysis of adult patients admitted with tuberculous arachnoiditis to a tertiary care center between July 2011 and November 2021. A total of 119 patients were included. Data collected included demographics, clinical presentation, cerebrospinal fluid (CSF) analysis, treatment regimens, and outcomes assessed using the Modified Rankin Scale at presentation and follow-up. Predictors of outcomes, including mortality, were analyzed using SPSS software.

The median age of patients was 34 years (standard deviation ± 14.13), with a male-to-female ratio of 53:47. Common presenting features included lower-limb weakness (67% with power ≤3/5) and bowel/bladder dysfunction (61%). Higher CSF leukocyte counts and human immunodeficiency virus (HIV) co-infection were significantly associated with worse outcomes; 63.6% of HIV-positive patients died before review. Elevated CSF protein levels were directly correlated with mortality. Longer duration of antitubercular therapy (ATT) was associated with improved outcomes. Statistical analysis identified HIV status and CSF protein count as independent predictors of mortality in TB arachnoiditis.

In this cohort of patients with tuberculous arachnoiditis, lower-limb weakness and bowel/bladder incontinence were the predominant clinical features. HIV seropositivity, elevated CSF protein levels, and duration of ATT significantly influenced patient outcomes. These findings underscore the importance of early diagnosis, prompt initiation of ATT, and management of associated factors like HIV in improving outcomes for patients with TB arachnoiditis.