Table 1.
Baseline demographic, clinical and investigative findings in patients with tuberculous meningitis (TBM) and cryptococcal meningitis (CM).
| TBM (n = 34) | Combined-CM (n = 19)a | TBM vs. combined-CM | CM-off-ART (n = 9) | TBM vs. CM-off-ART | ||||
| Median or n | (IQR or %) | Median or n | (IQR or %) | P-value | Median or n | (IQR or %) | P-value | |
| Demographic characteristics | ||||||||
| Age (years) | 33 | (28–44) | 34 | (27–39) | 0.61 | 34 | (25–38) | 0.61 |
| Sex (female) | 15 | (44) | 8 | (42) | 1.00 | 2 | (22) | 0.28 |
| Medical history | ||||||||
| History of previous TB | 11 | (32) | 9 | (47) | 0.38 | 5 | (56) | 0.26 |
| On TB treatment at presentation | 0 | (0) | 5 | (26) | 0.0041 | 1 | (11) | 0.21 |
| History of previous CM | 0 | (0) | 3 | (16) | 0.041 | 2 | (22) | 0.040 |
| Neurological symptoms | ||||||||
| Duration neurological symptoms (days) | 15 | (6–30) | 11 | (7–31) | 0.80 | 14 | (9–44) | 0.52 |
| Headache | 30 | (88) | 19 | (100) | 0.28 | 9 | (100) | 0.56 |
| Confusion | 13 | (38) | 2 | (11) | 0.05 | 1 | (11) | 0.23 |
| Vomiting | 21 | (61) | 10 | (53) | 0.57 | 5 | (56) | 1.00 |
| Visual disturbance | 11 | (32) | 10 | (53) | 0.24 | 6 | (67) | 0.12 |
| Clinical findings | ||||||||
| BMI | 19.95 | (18.33–22.7) | 19.73 | (18.03–23.07) | 0.97 | 18.72 | (17.55–19.53) | 0.14 |
| Neck stiffness | 27 | (79) | 16 | (84) | 1.00 | 8 | (89) | 1.00 |
| BMRC grade IIb | 16 | (47) | 5 | (26) | 0.16 | 3 | (33) | 0.71 |
| Focal neurological signs | 7 | (21) | 3 | (16) | 1.00 | 2 | (22) | 1.00 |
| Blood investigations | ||||||||
| Hemoglobin (g/dl) | 11.4 | (8.8–13.1) | 11.9 | (9.8–13.5) | 0.28 | 12.9 | (10.6–15) | 0.086 |
| Sodium (mmol/l) | 129 | (123–131) | 128 | (126–132) | 0.61 | 129 | (128–136) | 0.37 |
| C-reactive protein (mg/l) | 40 | (6–78) | 23 | (6–66) | 0.58 | 23 | (1–51) | 0.22 |
| CD4+ (cells/μl) | 113 | (69–199) | 55 | (23–77) | 0.0012 | 25 | (8–49) | 0.0001 |
| HIV viral load (log10 copies/ml) | 5.46 | (4.82–5.89) | 3.93 | (2.18–4.93) | < 0.0001 | 4.87 | (4.36–5.17) | 0.037 |
| CSF investigations | ||||||||
| Neutrophils, cells (×106/l) | 21 | (2–43) | 5 | (0–44) | 0.32 | 13 | (0–75) | 0.74 |
| Lymphocytes, cells (×106/l) | 177 | (87–339) | 90 | (7–132) | 0.031 | 90 | (4–182) | 0.14 |
| Protein (g/l) | 1.94 | (1.28–3.06) | 1.82 | (0.74–2.48) | 0.32 | 1.9 | (1.28–2.71) | 0.94 |
| Glucose (mmol/l) | 1.8 | (1.1–2.7) | 1.4 | (1.3–2.5) | 0.57 | 1.6 | (1.2–2.9) | 0.78 |
| CSF : blood glucose ratio | 0.3 | (0.2–0.53) | 0.24 | (0.21–0.45) | 0.42 | 0.24 | (0.22–0.48) | 0.78 |
| HIV viral load (log10 copies/ml)c | 6.05 | (5.43–6.56) | − | − | − | 5.56 | (4.52–5.80) | 0.03 |
ART, antiretroviral therapy, n; number; BMRC, British Medical Research Council; CSF, cerebrospinal fluid; IQR, interquartile range; TB, tuberculosis.
aCentral nervous system infection with Cryptococcus neoformans was confirmed by CSF culture in all but one CM patient in whom fungal culture was omitted in error; this patient had a positive CSF India ink stain and a CSF cryptococcal latex antigen test titer of 1 : 4096.
bNo patients had BMRC grade III disease. BMRC grade I: Glasgow Coma Scale (GCS) score of 15 with no focal neurologic signs; grade II: GCS score of 11–14 or GCS score of 15 with focal neurologic signs; grade III: GCS score of 10 or less.
cIn CM patients, HIV viral load was only performed in CSF of patients not receiving ART.