Neurological complications after tuberculous meningitis in a multi-state cohort in the United States

Abstract

Background and Purpose To assess the rate of neurological complications and mortality after tuberculous meningitis in the United States. Methods The authors performed a retrospective cohort study of all patients 18 years or older hospitalized for tuberculous meningitis in California between 2005–2010, New York between 2006–2012, and Florida between 2005–2012. Outcomes of interest were mortality and the following neurological complications: stroke, seizure, hydrocephalus requiring a ventriculoperitoneal shunt, vision impairment, and hearing impairment. Kaplan-Meier survival statistics were used to assess the cumulative rate of neurological complications and death. Cox proportional hazards regression was used to compare rates of complications in patients with and without human immunodeficiency virus (HIV) after adjustment for comorbidities. Results 806 patients with tuberculous meningitis were identified, among whom the cumulative rate of any complication or death was 55.4% (95% CI, 51.5–59.3%). More than two-thirds of complications occurred during the initial hospitalization for tuberculous meningitis. Individual neurological complications were not uncommon: the cumulative rate of stroke was 16.8% (95% CI, 14.0–20.0%), the rate of seizure was 18.8% (95% CI, 15.4–22.8%), and the rate of ventriculoperitoneal shunting was 8.4% (95% CI, 6.4–10.9%). Vision impairment occurred in 21.6% (95% CI, 18.5–25.1%) of patients and hearing impairment occurred in 6.8% (95% CI, 4.9–9.4%). The mortality rate was 21.5% (95% CI, 18.4–24.9%). Patients with HIV infection were not at increased risk of complications compared to patients without HIV (hazard ratio, 1.2; 95% CI, 0.9–1.6). Conclusions Tuberculous meningitis is associated with significant risk of neurological complications and death even in the United States.

Ventriculoperitoneal shunt insertion in human immunodeficiency virus infected adults: a systematic review and meta-analysis

“…Of the excluded studies, 16 concerned CM, [54][55][56][57][59][60][61][62][63][66][67][68][69]76,78,80 four TBM, 20,58,64,77 two bacterial meningitis, 70,71 one coccoidal meningitis, 8 and one included only cases of diagnostic uncertainty. 65 Two studies were published only in abstract form and did not present sufficient outcome data for inclusion.…”

“…The reasons for exclusion from this review are as follows: Two studies included patients with multiple, undocumented modalities of CSF diversion; 54,55 one study provided a just single case report; 56 three studies reported just one or two cases of surgical intervention and no survival/outcome data; 57,60,61 one study included 44 patients who underwent VPS in the context of CM but no outcome data; 80 two studies were review articles; 58,66 eight reported no HIV-infected patients who underwent VPS; 20,59,[62][63][64][65]71,[76][77][78] in one study reporting <50% HIV-infected patients it was not possible to associate outcome with HIV status 8 and; no relevant measures of survival/outcome were studied in four. [67][68][69][70]…”

Association between Fever during Admission and Outcome of Treatment in Tuberculous Meningitis Patients in Hasan Sadikin General Hospital Bandung

“…1 Tingkat mortalitas dari MTB tergolong tinggi dengan persentase 20-41%. 2 Beberapa faktor yang diketahui berhubungan dengan risiko kematian yang tinggi adalah Human Immunodeficiency Virus (HIV) (40-58%) 3,4 , tingkat keparahan penyakit, level kesadaran pasien, serta usia. Waktu pengukuran suhu tubuh, serta riwayat pasien dalam mengkonsumsi obat penurun panas juga tidak jelas tercatat dalam rekam medis dan hal ini mungkin memengaruhi hasil analisis data dalam penelitian ini.…”

The Global Neurological Burden of Tuberculosis

“…77 A multistate cohort study of 806 U.S. TBM patients identified rates of neurologic complications at 1 year following diagnosis for stroke (15%), seizures (12%), and visual impairment (19%). 78 Most of these complications occurred during the index hospitalization. A systematic review of 19 pediatric TBM studies, including a total of 1,636 children treated for TBM, reported a mortality rate of 19%, with a 54% risk of neurologic complications among survivors.…”