Long-term Mortality of Patients With Tuberculous Meningitis in New York City: A Cohort Study

Vinnard, Christopher; King, Liza; Munsiff, Sonal S.; Crossa, Aldo; Iwata, Kentaro; Pasipanodya, Jotam G.; Proops, Douglas; Ahuja, Shama D.

doi:10.1093/cid/ciw763

Cited by 38 publications

(49 citation statements)

References 34 publications

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“…8,9 INH is a cornerstone medication in the therapy of TBM, and patients with INH resistance have significantly worse outcomes. [10][11][12][13] The patient's initial TBM treatment did not include an adequate course of INH, and there was concern for recurrence. TB affects the spine predominantly in the form of extramedullary disease.…”

Section: Infectiousmentioning

confidence: 99%

Clinicopathology conference: 41‐year‐old woman with chronic relapsing meningitis

Beck

Ramachandran

Khan

et al. 2019

Annals of Neurology

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Section: Infectiousmentioning

confidence: 99%

Clinicopathology conference: 41‐year‐old woman with chronic relapsing meningitis

Beck

Ramachandran

Khan

et al. 2019

Annals of Neurology

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“…Among HIV-infected patients, the rate of mortality from TBM may reach more than 60.0% (6). TBM caused by drug-resistant strains of Mycobacterium tuberculosis has a mortality rate approaching 100% (7). The presenting clinical features of TBM are similar to those of other forms of subacute meningoencephalitides, making clinical diagnosis difficult and contributing to TBM's high mortality risk due to a delay in starting treatment (8,9).…”

mentioning

confidence: 99%

A Systematic Review and Meta-analysis of the Diagnostic Accuracy of Nucleic Acid Amplification Tests for Tuberculous Meningitis

et al. 2019

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The diagnosis of tuberculous meningitis (TBM) is difficult and poses a significant challenge to physicians worldwide. Recently, nucleic acid amplification (NAA) tests have shown promise for the diagnosis of TBM, although their performance has been variable. We undertook a systematic review and meta-analysis to evaluate the diagnostic accuracy of NAA tests with cerebrospinal fluid (CSF) samples against that of culture as the reference standard or a combined reference standard (CRS) for TBM. We searched the Embase, PubMed, Web of Science, and Cochrane Library databases for the relevant records. The QUADAS-2 tool was used to assess the quality of the studies. Diagnostic accuracy measures (i.e., sensitivity and specificity) were pooled with a random-effects model. All statistical analyses were performed with STATA (version 14 IC; Stata Corporation, College Station, TX, USA), Meta-DiSc (version 1.4 for Windows; Cochrane Colloquium, Barcelona, Spain), and RevMan (version 5.3; The Nordic Cochrane Centre, the Cochrane Collaboration, Copenhagen, Denmark) software. Sixty-three studies comprising 1,381 cases of confirmed TBM and 5,712 non-TBM controls were included in the final analysis. These 63 studies were divided into two groups comprising 71 data sets (43 in-house tests and 28 commercial tests) that used culture as the reference standard and 24 data sets (21 in-house tests and 3 commercial tests) that used a CRS. Studies which used a culture reference standard had better pooled summary estimates than studies which used CRS. The overall pooled estimates of sensitivity, specificity, positive likelihood ratio (PLR), and negative likelihood ratio (NLR) of the NAA tests against culture were 82% (95% confidence interval [CI], 75 to 87%), 99% (95% CI, 98 to 99%), 58.6 (95% CI, 35.3 to 97.3), and 0.19 (95% CI, 0.14 to 0.25), respectively. The pooled sensitivity, specificity, PLR, and NLR of NAA tests against CRS were 68% (95% CI, 41 to 87%), 98% (95% CI, 95 to 99%), 36.5 (95% CI, 15.6 to 85.3), and 0.32 (95% CI, 0.15 to 0.70), respectively. The analysis has demonstrated that the diagnostic accuracy of NAA tests is currently insufficient for them to replace culture as a lone diagnostic test. NAA tests may be used in combination with culture due to the advantage of time to result and in scenarios where culture tests are not feasible. Further work to improve NAA tests would benefit from the availability of standardized reference standards and improvements to the methodology.

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“…The magnitude of the association between initial isoniazid resistance and death was similar among 186 HIV-infected tuberculous meningitis patients in Vietnam, with the additional finding that excess mortality due to isoniazid resistance did not emerge until after the first 60 days of treatment [112]. Interestingly, this time-dependent relationship between isoniazid resistance and death was also observed among tuberculous meningitis patients in New York City, USA [113•] (Fig. 3).…”

Section: Drug-resistant Tuberculous Meningitismentioning

confidence: 74%

“…Among participants in the clinical trial of dexamethasone in Vietnam, 14% demonstrated severe disability at 5 years of follow-up, with no difference between the dexamethasone and placebo arms [71]. Among HIV-uninfected tuberculous meningitis patients in New York City who successfully completed treatment, there was no additional mortality burden when compared to population age- and sex-matched controls over a 10-year follow-up period, although differences in neurologic morbidities that did not impact survival were not measured [113•]. A multistate cohort study of 806 US tuberculous meningitis patients, conducted using administrative claims data, identified rates of neurologic complications at 1 year following diagnosis for stroke (15%), seizures (12%), and visual impairment (19%) [121].…”

Section: Long-term Neurologic Outcomes Among Survivorsmentioning

confidence: 99%

Tuberculous Meningitis in Children and Adults: New Insights for an Ancient Foe

Mezochow

Thakur

Vinnard

2017

Curr Neurol Neurosci Rep

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Purpose of Review Tuberculous meningitis is the most devastating manifestation of infection with Mycobacterium tuberculosis and represents a medical emergency. Approximately one half of tuberculous meningitis patients die or suffer severe neurologic disability. The goal of this review will be to review the pathogenic, clinical, and radiologic features of tuberculous meningitis and to highlight recent advancements in translational and clinical science. Recent Findings Pharmacologic therapy includes combination anti-tuberculosis drug regimens and adjunctive corticosteroids. It is becoming clear that a successful treatment outcome depends on an immune response that is neither too weak nor overly robust, and genetic determinants of this immune response may identify which patients will benefit from adjunctive corticosteroids. Recent clinical trials of intensified anti-tuberculosis treatment regimens conducted in Indonesia and Vietnam, motivated by the pharmacologic challenges of treating M. tuberculosis infections of the central nervous system, have yielded conflicting results regarding the survival benefit of intensified treatment regimens. More consistent findings have been observed regarding the relationship between initial anti-tuberculosis drug resistance and mortality among tuberculous meningitis patients. Summary Prompt initiation of anti-tuberculosis treatment for all suspected cases remains a key aspect of management. Priorities for research include the improvement of diagnostic testing strategies and the optimization of host-directed and anti-tuberculosis therapies.

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Long-term Mortality of Patients With Tuberculous Meningitis in New York City: A Cohort Study

Cited by 38 publications

References 34 publications

Clinicopathology conference: 41‐year‐old woman with chronic relapsing meningitis

Clinicopathology conference: 41‐year‐old woman with chronic relapsing meningitis

A Systematic Review and Meta-analysis of the Diagnostic Accuracy of Nucleic Acid Amplification Tests for Tuberculous Meningitis

Tuberculous Meningitis in Children and Adults: New Insights for an Ancient Foe

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