Tuberculous meningitis in adults: review of 48 cases

The cases of 48 adult patients with tuberculous meningitis who were admitted to intensive care unit (ICU) between 1982 and 1993 were reviewed. An underlying disease was present in 24 patients (50%), including 10 with human immunodeficiency virus infection. Forty-seven patients were referred to the ICU because of neurological deterioration; 22 were comatose at admission. Forty-six patients received antituberculous treatment; 36 required mechanical ventilatory support, and 16 underwent neurosurgery. Thirty-one patients died within 4 months after admission, and the remaining 17 were alive at a 1-year follow-up. Univariate prognostic analysis selected three variables, all assessed at admission, associated with outcome: time to onset of treatment of > or = 3 days (P = .003), coma (P = .006), and simplified acute physiology score of > 11 (P = .03). Thus, the outcome of tuberculous meningitis is mainly determined by the clinical stage at admission and the delay in starting treatment. These findings underscore the need to initiate early therapy as soon as the diagnosis of tuberculous meningitis is suspected.