The global burden of tuberculous meningitis in adults: A modelling study

Abstract

Tuberculous meningitis (TBM) is the most lethal form of tuberculosis. The incidence and mortality of TBM is unknown due to diagnostic challenges and limited disaggregated reporting of treated TBM by existing surveillance systems. We aimed to estimate the incidence and mortality of TBM in adults (15+ years) globally. Using national surveillance data from Brazil, South Africa, the United Kingdom, the United States of America, and Vietnam, we estimated the fraction of reported tuberculosis that is TBM, and the case fatality ratios for treated TBM in each of these countries. We adjusted these estimates according to findings from a systematic review and meta-analysis and applied them to World Health Organization tuberculosis notifications and estimates to model the global TBM incidence and mortality. Assuming the case detection ratio (CDR) for TBM was the same as all TB, we estimated that in 2019, 164,000 (95% UI; 129,000–199,000) adults developed TBM globally; 23% were among people living with HIV. Almost 60% of incident TBM occurred in males and 20% were in adults 25–34 years old. 70% of global TBM incidence occurred in Southeast Asia and Africa. We estimated that 78,200 (95% UI; 52,300–104,000) adults died of TBM in 2019, representing 48% of incident TBM. TBM case fatality in those treated was on average 27%. Sensitivity analysis assuming improved detection of TBM compared to other forms of TB (CDR odds ratio of 2) reduced estimated global mortality to 54,900 (95% UI; 32,200–77,700); assuming instead worse detection for TBM (CDR odds ratio of 0.5) increased estimated mortality to 125,000 (95% UI; 88,800–161,000). Our results highlight the need for improved routine TBM monitoring, especially in high burden countries. Reducing TBM incidence and mortality will be necessary to achieve the End TB Strategy targets.

Paroxysmal sympathetic hyperactivity syndrome in tuberculous meningitis with paradoxical reaction

“…Tuberculosis remains a significant public health issue around the world, in which Indonesia is a one of the most significant contributors to the global burden [9] . Tuberculosis of brain, such as tuberculous meningitis and tuberculoma, is the most lethal form of tuberculosis with up to 40 % mortality [10] , [11] . The primary management goals are to reduce intracranial pressure and improve cerebral perfusion, while also to eradicate the bacteria and to lessen intracerebral inflammation [12] .…”

Tuberculous meningomyelitis: Report of a case

“…Early evidence for TB-M includes lymphocytic pleocytosis and normal or low glucose levels on CSF and a positive IGRA test [4]. Central nervous system infarctions, communicating hydrocephalus and basal meningeal, and spinal cord enhancement on post-contrast are common findings in MRI [3,[5][6][7].…”

Improving Technology to Diagnose Tuberculous Meningitis: Are We There Yet?

“…Tuberculous meningitis (TBM) is the deadliest form of tuberculosis (TB). In 2019, an estimated 164,000 cases occurred globally, of whom 23% were in people living with HIV (PLHIV) ( 1 ). Mortality is 10–24% in HIV-negative individuals, and 46–67% in PLHIV ( 2 , 3 ).…”