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Predictors of outcome in patients with tuberculous meningitis

Authors: Hosoglu, S.1; Geyik M., F.1; Balik, I.2; Aygen, B.3; Erol, S.4; Aygencel T., G.5; Mert, A.6; Saltoglu, N.7; Dokmetas, I.8; Felek, S.9; Sunbul, M.10; Irmak, H.11; Aydin, K.12; Kokoglu O., F.1; Ucmak, H.1; Altindis, M.13; Loeb, M.14

Source: The International Journal of Tuberculosis and Lung Disease, Volume 6, Number 1, January 2002 , pp. 64-70(7)

Publisher: International Union Against Tuberculosis and Lung Disease

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Abstract:

OBJECTIVE: To assess predictors of mortality and neurological sequelae in patients with tuberculous meningitis (TBM).

METHODS: Patients with TBM treated at 12 university hospitals in Turkey between 1985 and 1997 were evaluated using a standardised protocol applied retrospectively. Variables associated with hospital mortality as well as with the presence of neurological sequelae at 6 months were determined using logistic regression models.

RESULTS: Four hundred and thirty-four patients between the ages of 13 and 83 years (mean 33 years) were evaluated. Sixty-eight per cent of these patients presented with Medical Research Council Stage II or III. One hundred and one patients (23.3%) died and 67 (27%) of evaluable survivors had neurological sequelae. In multivariable analysis, convulsion (OR 3.3, 95%CI 1.2–9.0, P = 0.02), comatose mental status (OR 6.0, 95%CI 3.6–10.2, P = 0.01), and delayed or interrupted treatment (OR 5.1, 95%CI 2.4–11.2, P = 0.01) were shown to be predictors for mortality. The presence of extra-meningeal tuberculosis (OR 2.1, 95%CI 1.1–4.2, P = 0.035), cranial nerve palsy (OR 2.6, 95%CI 1.4–4.2, P = 0.01), hemiparesia/focal weakness (OR 9.3, 95%CI 3.8–22.6, P = 0.01), hemiplegia/multiple neurological deficit (OR 7.1, 95%CI 2.14–23.38, P = 0.01) and drowsiness (OR 4.2, 95%CI 2.04–8.82, P = 0.01) were independent predictors of neurological sequelae at 6 months following hospital discharge.

CONCLUSION: The results of this study emphasise the importance of prompt and uninterrupted anti-tuberculosis therapy for tuberculous meningitis. The presence of seizures or coma on admission to hospital are important predictors for mortality, while the presence of focal neurological signs is a predictor for persistent neurological sequelae in survivors.

Keywords: independent factors; outcome; tuberculous meningitis

Document Type: Regular Paper

Affiliations: 1: Departments of Clinical Microbiology and Infectious Diseases, Dicle University Hospital, Diyarbakır, Turkey 2: Departments of Clinical Microbiology and Infectious Diseases, Ankara University Hospital, Ankara, Turkey 3: Departments of Clinical Microbiology and Infectious Diseases, Erciyes University Hospital, Kayseri, Turkey 4: Departments of Clinical Microbiology and Infectious Diseases, Ataturk University Hospital, Erzurum, Turkey 5: Departments of Clinical Microbiology and Infectious Diseases, Hacettepe University Hospital, Ankara, Turkey 6: Departments of Clinical Microbiology and Infectious Diseases, Cerrahpasa Hospital, Istanbul, Turkey 7: Departments of Clinical Microbiology and Infectious Diseases, Çukurova University Hospital, Adana, Turkey 8: Departments of Clinical Microbiology and Infectious Diseases, Cumhuriyet University Hospital, Sivas, Turkey 9: Departments of Clinical Microbiology and Infectious Diseases, Firat University Hospital, Elazıg, Turkey 10: Departments of Clinical Microbiology and Infectious Diseases, Ondokuz Mayıs University Hospital, Samsun, Turkey 11: Departments of Clinical Microbiology and Infectious Diseases, Yuzuncu Yil University Hospital, Van, Turkey 12: Departments of Clinical Microbiology and Infectious Diseases, Karadeniz Technique University Hospital, Trabzon, Turkey 13: Departments of Clinical Microbiology and Infectious Diseases, Kocatepe University Hospital, Afyon, Turkey 14: Departments of Clinical Microbiology and Infectious Diseases, Hamilton Civic Hospitals and McMaster University, Hamilton, Ontario, Canada

Publication date: January 1, 2002

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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