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Tuberculous meningitis at a large inner-city medical center
M T Porkert1, M Sotir, P Parrott-Moore
1Department of Medicine, Emory University School of Medicine, Atlanta, GA 30303, USA.
Abstract:
Tuberculosis in the United States has become primarily an inner-city disease. We examined the epidemiology of culture-confirmed tuberculous meningitis among patients cared for at an urban public hospital in Atlanta. During an 11.5-year period (January 1984-June 1995) cerebrospinal fluid cultures for Mycobacterium tuberculosis were positive in 34 patients, accounting for 1.5% of all culture-confirmed tuberculosis cases. All patients were born in the United States, 31 (91%) were black, 16 (47%) of 34 were human immunodeficiency virus (HIV) seropositive, 9 (26.5%) were HIV seronegative, and 9 (26.5%) had an unknown HIV serostatus. No significant differences were seen in clinical presentation, cerebrospinal fluid, or other laboratory data between HIV seropositive and HIV seronegative/ unknown groups, except for a lower serum white blood cell count among HIV seropositive patients. Mortality was striking; 14 (41.2%) died because of tuberculous meningitis despite appropriate therapy initiated a mean of 3 days after admission. Six survivors had permanent neurologic sequelae. Univariate analysis of outcome was not statistically associated with any measured demographic, laboratory value, stage at presentation, treatment regimen, or HIV serostatus. Multivariate analysis of outcome using 13 independent variables also demonstrated no significant association between these variables and outcome, although a trend was seen for increased mortality for white people (P = 0.09) and increasing age (P = 0.09). Tuberculous meningitis among inner-city residents remains a devastating disease associated with high morbidity and mortality that has changed little during the past 4 decades. HIV infection does not change markedly the clinical presentation or the response to therapy.
Insights
Tuberculous meningitis remains a severe inner-city disease with high mortality, even with treatment. Human immunodeficiency virus (HIV) infection did not significantly alter the presentation or outcomes of this devastating tuberculosis form.
Area of Science:
- Epidemiology
- Infectious Diseases
- Neurology
Background:
- Tuberculosis (TB) has shifted to inner-city populations in the United States.
- Tuberculous meningitis (TBM) is a severe manifestation of TB, particularly in urban settings.
Purpose of the Study:
- To examine the epidemiology of culture-confirmed tuberculous meningitis.
- To analyze patient characteristics, clinical presentation, and outcomes.
- To assess the impact of human immunodeficiency virus (HIV) serostatus on TBM.
Main Methods:
- Retrospective analysis of 34 culture-confirmed TBM cases.
- Data collected over an 11.5-year period (January 1984-June 1995) at an urban public hospital.
- Comparison of outcomes between HIV-seropositive and HIV-seronegative/unknown groups.
Main Results:
- TBM accounted for 1.5% of all culture-confirmed TB cases.
- High mortality rate (41.2%) observed, with 14 deaths.
- Six survivors experienced permanent neurologic sequelae.
- No significant differences in presentation or laboratory data between HIV groups, except lower white blood cell count in HIV-positive patients.
- Neither univariate nor multivariate analyses showed significant associations with outcome variables, though trends suggested increased mortality for white individuals and older age.
Conclusions:
- Tuberculous meningitis in inner-city residents continues to be a devastating disease with high morbidity and mortality.
- HIV infection did not substantially alter the clinical presentation or therapeutic response in TBM patients.
- The disease's impact has remained largely unchanged over the past four decades.