Clinical presentations among adult patients with tuberculous meningitis

Kamal Ahmed; Md Mubin Uddin Akhanji; Md Shahidul Islam; K. M. Ahasan Ahmed; Md Zakirul Islam

doi:10.18203/2320-6012.ijrms20231601

Authors

Kamal Ahmed Department of Neurology, North East Medical College and Hospital, Sylhet, Bangladesh
Md Mubin Uddin Akhanji Department of Psychiatry, M. A. G. Osmani Medical College, Sylhet, Bangladesh
Md Shahidul Islam Department of Medicine, Government Employee Hospital, Fulbaria, Dhaka, Bangladesh
K. M. Ahasan Ahmed Department of Neurology, National Institute of Neurosciences and Hospital, Dhaka, Bangladesh
Md Zakirul Islam Department of Medicine, Kurmitola General Hospital, Dhaka, Bangladesh

DOI:

https://doi.org/10.18203/2320-6012.ijrms20231601

Keywords:

Clinical presentations, Meningitis, Respiratory, Tuberculosis

Abstract

Background: Bangladesh is a country with a high burden of pulmonary as well as extrapulmonary tuberculosis. TBM is a particularly important public health issue in our country. Identifying prognostic predictors would improve the quality of management and ultimately will prevent long-term mortality and morbidity. The aim of the study was to observe and identify the most common clinical presentations among patients with tuberculous meningitis.

Methods: This hospital-based prospective cohort study was carried out at the in-patient Department of Clinical Neurology at the National Institute of Neurosciences and Hospital (NINS and H), Dhaka, Bangladesh from October 2016 to September 2017, 1 year. A total of 54 patients admitted to the hospital with features of tuberculous meningitis (TBM) were selected for the study following inclusion and exclusion criteria.

Results: Over 70% of patients were adolescents or young adults with a mean age of 28.2±12.3 years. The majority (48.2%) of the participants were from TBM stage II, while 37% were from stage III of TBM. Fever, headache, and systematic symptoms were the most frequent clinical presentations. The median delay in treatment was 30 days. Interruption in anti-TB treatment was reported in 3 (9.3%) cases.

Conclusions: The study found that among possible TBM cases, the most frequent clinical features were fever, headache, and systematic symptoms. Focal neurological deficit and cerebral nerve palsy also had a high prevalence among the participants. The majority of the participants were young adults and female prevalence was high in the present study. The majority were from stage II TB among the study participants.

Metrics

Metrics Loading ...

References

Gallardo CR, Comas DR, Rodríguez AV, i Figuls MR, Parker LA, Caylà J, et al. Fixed‐dose combinations of drugs versus single‐drug formulations for treating pulmonary tuberculosis. Cochrane Data Syst Revi. 2016(5).

WHO. Global Tuberculosis Report, 2017. Available at: https://www.who.int/publications-detail-redirect/9789241565516.

NTP. National Guidelines and Operational Manual for Tuberculosis Control. 5th ed. Edited by B. DGHS. Dhaka; 2013.

Tai ML, MOHD NOR H, Rahmat K, Viswanathan S, ABDUL KADIR KA, Ramli N, et al. Neuroimaging findings are sensitive and specific in diagnosis of tuberculous meningitis. Neurol Asia. 2017;22(1):15-23.

Pai M, Flores LL, Pai N, Hubbard A, Riley LW, Colford JM. Diagnostic accuracy of nucleic acid amplification tests for tuberculous meningitis: a systematic review and meta-analysis. Lancet Infect Dis. 2003;3(10):633-43.

Prasad K, Singh MB, Ryan H. Corticosteroids for managing tuberculous meningitis. Cochrane Database of Systematic Reviews. 2016(4):CD001446.

Erdem H, Ozturk-Engin D, Tireli H, Kilicoglu G, Defres S, Gulsun S, et al. Hamsi scoring in the prediction of unfavorable outcomes from tuberculous meningitis: results of Haydarpasa-II study. J Neurol. 2015;262(4):890-8.

Lau KK, Yu I, Chan A, Wong L, Tam CM, Sheng B, et al. A registry of tuberculous meningitis in Hong Kong. Intern J Tuber Lung Dis. 2005;9(12):1391-7.

Thwaites G, Fisher M, Hemingway C, Scott G, Solomon T, Innes J. British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children. J Infect. 2009;59(3):167-87.

Erdem HA, Ozturk‐Engin D, Elaldi NA, Gulsun S, Sengoz G, Crisan A, et al. The microbiological diagnosis of tuberculous meningitis: results of H aydarpasa‐1 study. Clin Microb Infect. 2014;20(10):O600-8.

Misra UK, Kalita J, Roy AK, Mandal SK, Srivastava M. Role of clinical, radiological, and neurophysiological changes in predicting the outcome of tuberculous meningitis: a multivariable analysis. J Neurol Neuros Psych. 2000;68(3):300-3.

Yasar KK, Pehlivanoglu F, Sengoz G. Predictors of mortality in tuberculous meningitis: a multivariate analysis of 160 cases. Intern J Tuber Lun Dis. 2010;14(10):1330-5.

Thwaites GE, van Toorn R, Schoeman J. Tuberculous meningitis: more questions, still too few answers. Lancet Neurol. 2013;12(10):999-1010.

Lee HG, William T, Menon J, Ralph AP, Ooi EE, Hou YA, Sessions O, Yeo TW. Tuberculous meningitis is a major cause of mortality and morbidity in adults with central nervous system infections in Kota Kinabalu, Sabah, Malaysia: an observational study. BMC Infect Dis. 2016;16(1):1-8.

Yao Y, Zhang JT, Yan B, Gao T, Xing XW, Tian CL, et al. Voriconazole: a novel treatment option for cryptococcal meningitis. Infectious Diseases. 2015;47(10):694-700.

Sarkar DN, Hossain MI, Shoab AK, Quraishi FA. Presentation of tuberculous meningitis patients: Study of 30 cases. Med Today. 2013;25(1):32-5.

Gupta M, Bajaj BK, Khwaja G. Paradoxical response in patients with CNS tuberculosis. J Associa Phy India. 2003;51:257-60.

Hsu PC, Yang CC, Ye JJ, Huang PY, Chiang PC, Lee MH. Prognostic factors of tuberculous meningitis in adults: a 6-year retrospective study at a tertiary hospital in northern Taiwan. J Microbiol Immunol Infect. 2010;43(2):111-8.

Thwaites GE, Nguyen HD, Hoang TQ, Do TT, Nguyen TC, Nguyen QH, et al. Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults. New England J Med. 2004;351(17):1741-51.

Roos KL, KL T. Meningitis, encephalitis, brain abscess, and empyema. In: Hauser SL, SA. J. (ed.) Harrison’s Neurology in Clinical Medicine. 4th ed. New York: The Mc Graw Hill Companies, Inc.; 2017:555–556.

Marais S, Thwaites G, Schoeman JF, Török ME, Misra UK, Prasad K, et al. Tuberculous meningitis: a uniform case definition for use in clinical research. Lancet Infect Dis. 2010;10(11):803-12.

Nhu NT, Heemskerk D, Thu DD, Chau TT, Mai NT, Nghia HD, et al. Evaluation of GeneXpert MTB/RIF for diagnosis of tuberculous meningitis. J Clin Microbiol. 2014;52(1):226-33.

Kalita J, Misra UK. Outcome of tuberculous meningitis at 6 and 12 months: a multiple regression analysis. Inter J Tubercu Lung Dis. 1999;3(3):261-5.