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Tuberculous meningitis in the southwest United States: a community-based study
L E Davis1, K R Rastogi, L C Lambert
1Neurology Service, Albuquerque VA Medical Center, NM 87108.
Abstract:
This community-based study analyzed 54 patients with definite or probable tuberculous meningitis (TBM) in New Mexico from 1970 through 1990. Patients ranged in age from 4 months to 86 years. The highest age-specific incidence occurred in the elderly, but 22% of patients were less than 10 years old. Native American patients were overrepresented. Patients were as likely to live in small towns as in large urban cities. Symptoms were present for a median of 13 days before admission. The majority of patients had fevers, headache, stiff neck, and mental changes, such as confusion or lethargy. No patient was admitted comatose. Focal neurologic signs were present in 33%. Laboratory testing found hyponatremia in 79%, pulmonary infiltrates on chest x-ray in 40%, ventricular dilatation on CT or MRI in 52%, and tuberculomas in 16%. PPD skin tests were positive in 64%. CSF cultures grew Mycobacterium tuberculosis in 50%, but colony counts were always lower than 10(2)/ml. As a consequence, acid-fast stains of CSF sediment were reported as positive in only 4%. Six patients were not diagnosed during the hospitalization and died of complications. Twenty-three percent of patients who were appropriately treated also died of complications during the initial hospitalization. Tuberculous meningitis continues to be an important disease in small communities, and affects all ages and ethnic and socioeconomic backgrounds.
Insights
Tuberculous meningitis (TBM) affected all ages and backgrounds in New Mexico, with overrepresentation in Native Americans. Early diagnosis and treatment remain critical for improving outcomes in this persistent infectious disease.
Area of Science:
- Infectious Diseases
- Neurology
- Public Health
Background:
- Tuberculous meningitis (TBM) remains a significant public health concern, particularly in diverse communities.
- Understanding the epidemiology and clinical presentation of TBM is crucial for timely diagnosis and management.
Purpose of the Study:
- To analyze the demographic, clinical, and diagnostic features of tuberculous meningitis (TBM) in a New Mexico population over a 20-year period.
- To identify challenges in TBM diagnosis and factors associated with patient outcomes.
Main Methods:
- Community-based retrospective analysis of 54 patients with definite or probable TBM diagnosed between 1970 and 1990.
- Review of patient demographics, clinical symptoms, neurological signs, laboratory results, and diagnostic tests (PPD, CSF culture, imaging).
Main Results:
- TBM affected all age groups, with notable incidence in the elderly and children under 10. Native American patients were overrepresented.
- Common symptoms included fever, headache, and altered mental status. Hyponatremia (79%) and positive PPD tests (64%) were frequent. CSF cultures identified Mycobacterium tuberculosis in 50% of cases.
- Diagnostic challenges persisted, with 6 patients misdiagnosed and 23% of treated patients dying during hospitalization.
Conclusions:
- Tuberculous meningitis (TBM) continues to be an important disease affecting diverse populations in community settings.
- The study highlights the need for increased awareness and improved diagnostic strategies for TBM, especially in at-risk populations.
- Despite advances, TBM poses a significant mortality risk, underscoring the importance of prompt and accurate diagnosis and treatment.