Clinical features, long-term clinical outcomes, and prognostic factors of tuberculous meningitis in West China: a multivariate analysis of 154 adults

Li, Kunyi; Tang, Hong; Yang, Yi; Li, Qin; Zhou, Yuchuan; Ren, Min; Long, Xianghua; Shen, Wenjing; Hu, Rong; Wang, Xuefeng; Zeng, Kebin

doi:10.1080/14787210.2017.1309974

Cited by 34 publications

(31 citation statements)

References 32 publications

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“…The study populations of these studies came from nine countries. Seventeen studies were conducted in countries currently on the WHO list of countries with high TB burden [13–25, 27–29, 31]. The majority of patients were male (61.2%).…”

Section: Resultsmentioning

confidence: 99%

Treatment outcomes of tuberculous meningitis in adults: a systematic review and meta-analysis

et al. 2019

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BackgroundTuberculous meningitis is the most devastating presentation of disease with Mycobacterium tuberculosis. We sought to evaluate treatment outcomes for adult patients with this disease.MethodsThe Ovid MEDLINE, EMBASE, Cochrane Library and Web of Science databases were searched to identify all relevant studies. We pooled appropriate data to estimate treatment outcomes at the end of treatment and follow-up.ResultsAmong the articles identified, 22 met our inclusion criteria, with 2437 patients. In a pooled analysis, the risk of death was 24.7% (95%CI: 18.7–31.9). The risk of neurological sequelae among survivors was 50.9% (95%CI: 40.2–61.5). Patients diagnosed in stage III or human immunodeficiency virus (HIV) positive were significantly more likely to die (64.8, 53.4% respectively) during treatment. The frequency of cerebrospinal fluid (CSF) acid-fast-bacilli smear positivity was 10.0% (95% CI 5.5–17.6), 23.8% (15.2–35.3) for CSF culture positivity, and 22.3% (17.8–27.5) for CSF polymerase chain reaction positivity. We found that the headache, fever, vomiting, and abnormal chest radiograph were the most common symptoms and diagnostic findings among tuberculous meningitis patients.ConclusionsDespite anti-tuberculosis treatment, adult tuberculous meningitis has very poor outcomes. The mortality rate of patients diagnosed in stage III or HIV co-infection increased significantly during treatment.

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Section: Resultsmentioning

confidence: 99%

Treatment outcomes of tuberculous meningitis in adults: a systematic review and meta-analysis

et al. 2019

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“…Gunawan and colleagues have reported abnormal EEG activity in 75% of the patients, out of them 77% had epileptogenic activities; moreover, they found a strong correlation between epileptic spikes on EEG and the development of clinical seizures [30]. However, a recent study from China has concluded that the presence of epileptiform discharge on EEG was not associated with poorer outcome [75]. In TBM patients with convulsions, epilepitform discharges are less common finding relative to slow activity, especially in adult patients.…”

Section: Eeg Findingsmentioning

confidence: 99%

The prevalence, characteristics and outcome of seizure in tuberculous meningitis

Abdulaziz

Zhou

2020

Acta Epileptologica

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Seizures are a common finding in patients with tuberculous meningitis (TBM), and associate with four times increased risk of death and neurological disability, especially in children. It has been reported that brain inflammation, diffuse neuronal injury, and reactive gliosis may all contribute to the pathogenesis of seizures in TBM. Early seizure onset may be associated with meningeal irritation and cerebral oedema; while, the late seizures are usually due to infarction, hydrocephalus, tuberculoma and paradoxical response. Moreover, recurrent uncontrolled seizures can evolve to status epileptics resulting in an increased risk of chronic epilepsy and poor prognosis. Therefore, this review aimed to assess the frequency of seizures in patients with TBM, and discuss the etiologies, mechanisms, and characteristics of seizures in TBM. Besides, we have searched the literature to identify the prognostic factors for chronic epilepsy after TBM.

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“…Thus these findings were comparable to various studies. [22,23] The CSF ADA had a median of 12 U/L while mean values being 14.4 ± 6.9 U/L and 9.6 ± 4.1 U/L in studies by Kaur et al, [11] and Gambhir et al, [24] Anemia Hb< 10 gm/dl was observed in 14.2% cases which was lesser than other studies. [12,2] Hyponatremia was seen in 60% of the patients which was comparable to other studies.…”

Section: Malik and Singh: Clinical Correlates Of Tubercular Meningitismentioning

confidence: 82%

Study of Clinical Correlates of Tubercular Meningitis in a Tertiary Care Centre in Moradabad

Malik¹,

Singh²

2019

AJM

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Background: Tuberculosis continues to remain a leading cause of mortality worldwide with tubercular meningitis being the most common type of central nervous system tuberculosis that is associated with significant morbidity and mortality if not identified and treated promptly. Due to meager amount of published data and lack of evaluation of the western UP population, this study was conducted in order to observe a detailed clinical course of the disease as well as to analyze predictors of morbidity and mortality in patients of TBM admitted at a tertiary care hospital in Moradabad.Subjects and Methods: A total of 120 patients with diagnosis of TBM as per the diagnostic criteria of the study were included and all their information and features recorded and treatment done as per guidelines and a follow-up done at 3 months using Barthel Index.Results: Multivariate logistic regression analysis of various factors revealed age of the patient (p=0.04), duration of symptoms (p=0.002), stage of TBM on presentation (p=0.001), TLC>9000 (p=0.006), low CSF glucose (p=0.01), hyponatremia (p=0.04), hypoalbuminemia (p=0.007) and hydrocephalus (p=0.04) on neuroimaging were significant risk factors of mortality and morbidity in adult patients of TBM.Conclusion: The current study may provide components for the composition of a score to predict outcome using the significant poor prognostic factors that were recognized in this study. This can be utilised for prompt employment of rigorous management remedies in order to reduce patients' morbidity and mortality.

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Clinical features, long-term clinical outcomes, and prognostic factors of tuberculous meningitis in West China: a multivariate analysis of 154 adults

Abstract: Mortality and disability associated with TBM are high in China. Limb weakness, GCS scores, cranial-nerve palsy and hydrocephalus were independent predictors of poor outcomes, and AGR, NLR, D-dimer, and EEG abnormalities may be prognostic factors of TBM.

Cited by 34 publications

References 32 publications

Treatment outcomes of tuberculous meningitis in adults: a systematic review and meta-analysis

Treatment outcomes of tuberculous meningitis in adults: a systematic review and meta-analysis

The prevalence, characteristics and outcome of seizure in tuberculous meningitis

Study of Clinical Correlates of Tubercular Meningitis in a Tertiary Care Centre in Moradabad

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