Table 1. Characteristics and outcomes of patients with tuberculosis meningitis by treatment type characteristics.
| Overall n = 237 (%) | Drug Susceptible n = 201 (%) | Drug Resistant n = 36 (%) | p-value* | |
|---|---|---|---|---|
| Mean age, years (SD) | 44 (17) | 45 (18) | 40 (9) | 0.28 |
| Male sex | 143 (60) | 117 (58) | 26 (72) | 0.16 |
| Weight < 50 kilograms | 12 (4) | 11 (5) | 1 (3) | >0.99 |
| History of imprisonment | 24 (10) | 15 (7) | 9 (25) | <0.01 |
| Contact to active tuberculosis case | 25 (11) | 22 (11) | 3 (8) | 0.86 |
| HIV | ||||
| HIV infected | 34 (14) | 16 (8) | 18 (50) | <0.01 |
| New diagnosis | 12 (5) | 10 (5) | 2 (6) | >0.99 |
| CD4, cells/ul, median (IQR) [n = 34] | 40 (20, 110) | 63 (30, 173) | 31 (18, 54) | 0.11 |
| Currently on ART | 14 (6) | 6 (3) | 8 (26) | <0.01 |
| Co-morbidities | ||||
| Hepatitis C virus antibody positive | 31 (13) | 14 (7) | 17 (47) | <0.01 |
| History of intravenous drug use | 17 (7) | 6 (3) | 11 (31) | <0.01 |
| Alcohol Use Disorder | 9 (4) | 6 (3) | 3 (8) | 0.14 |
| Diabetes | 12 (5) | 10 (5) | 2 (6) | >0.99 |
| Case Definition | ||||
| New Case | 197 (83) | 181 (90) | 16 (44) | <0.01 |
| Relapse | 11 (5) | 9 (4) | 2 (6) | |
| Treatment after LTFU | 12 (5) | 3 (1) | 9 (25) | |
| Treatment after failure | 5 (2) | 1 (1) | 4 (11) | |
| Other | 12 (5) | 7 (3) | 5 (14) | |
| Presentation | ||||
| Neurological Status | 0.01 | |||
| TBM Grade 1/Normal | 33 (14) | 32 (16) | 1 (3) | |
| TBM grade 2/Mild | 142 (60) | 123 (62) | 19 (54) | |
| TBM grade 3/Severe | 60 (26) | 45 (23) | 15 (43) | |
| Unknown | 2 | 1 | 1 | |
| Days since first neurologic symptom, median (IQR) | 10 (7, 15) | 10 (7, 15) | 10 (7, 14) | 0.95 |
| Altered Mental Status | 195 (82) | 163 (81) | 32 (89) | |
| Fever | 214 (90) | 183 (91) | 31 (86) | 0.42 |
| Headache | 217 (92) | 186 (93) | 31 (86) | 0.29 |
| Vomiting | 147 (62) | 132 (66) | 15 (42) | 0.02 |
| Nuchal rigidity | 219 (92) | 188 (94) | 31 (86) | 0.14 |
| Seizures | 23 (10) | 19 (10) | 4 (11) | 0.39 |
| Cranial nerve palsy | 63 (10) | 57 (28) | 6 (17) | 0.23 |
| Urinary retention | 51 (22) | 43 (21) | 8 (22) | 0.62 |
| Hemiplegia | 17 (7) | 12 (6) | 5 (14) | 0.22 |
| Paraplegia | 18 (8) | 16 (8) | 2 (6) | >0.99 |
| Site of Disease | ||||
| Evidence of extra-CNS disease | 70 (30) | 44 (22) | 26 (72) | <0.01 |
| Pulmonary disease | 60 (25) | 35 (15) | 25 (69) | <0.01 |
| Care prior to admission | ||||
| Received antibiotic therapy prior to admission | 88 (41) | 79 (41) | 9 (35) | 0.15 |
| Baseline CSF data | ||||
| CSF WCC, cells/ul, mean (SD) | 213 (263) | 226 (280) | 144 (116) | 0.09 |
| CSF protein, mg/dl, mean (SD) | 177 (294) | 175 (305) | 189 (229) | 0.15 |
| CSF glucose, mg/dl, mean (SD) | 42 (24) | 44 (24) | 31 (20) | <0.01 |
| Microbiology | ||||
| Microbiologic confirmation at any site | 90 (38) | 59 (29) | 31 (86) | <0.01 |
| Microbiologic confirmation in CNS sample |
48 (20) | 26 (13) | 22 (61) | <0.01 |
| CSF Xpert positive | 29 (12) | 14 (7) | 15 (42) | <0.01 |
| CSF culture positive | 38 (16) | 19 (10) | 19 (53) | <0.01 |
| Microbiologic confirmation from non-CNS site only | 42 (18) | 33 (16) | 9 (25) | 0.31 |
| Clinical diagnosis | 147 (62) | 142 (71) | 5 (14) | <0.01 |
| Imaging | ||||
| Either MRI brain or CT head performed | 166 (70) | 144 (72) | 22 (61) | 0.28 |
| Any CNS imaging abnormality | 135 (57) | 114 (57) | 21 (58) | >0.99 |
| Mean baseline laboratory data | ||||
| Hemoglobin (SD) | 12.3 (2.0) | 12.4 (1.9) | 11.5 (2.2) | 0.02 |
| Sodium (SD) | 131 (8) | 132 (8) | 129 (8) | 0.14 |
| Creatinine (SD) | 79 (26) | 81 (27) | 67 (15) | <0.01 |
| Albumin (SD) | 34 (7) | 34 (7) | 34 (6) | 0.53 |
| Case definition 1 | <0.01 | |||
| Definite TBM | 48 (20) | 26 (13) | 22 (61) | |
| Probable | 31 (13) | 24 (12) | 7 (19) | |
| Possible | 153 (65) | 146 (73) | 7 (19) | |
| Unlikely | 5 (2) | 5 (2) | 0 | |
| Initial treatment outcome | ||||
| Cure/Completed | 148 (63) | 140 (69) | 8 (22) | <0.01 |
| Lost to follow up | 15 (6) | 13 (6) | 2 (6) | |
| Treatment failure | 4 (2) | 4 (2) | 0 (0) | |
| Death | 50 (21) | 29 (14) | 21 (58) | |
| Unknown or not evaluated | 20 (8) | 15 (7) | 5 (14) | |
| Long term mortality | ||||
| Death | 73 (31) | 49 (24) | 24 (67) | <0.01 |
| Alive | 161 (68) | 150 (75) | 11 (31) | |
| Not determined | 3 (1) | 2 (1) | 1 (3) | |
| Died after treatment completion | 23 (10) | 20 (10) | 3 (8) | |
| Follow-up time, days (Median, IQR) | 1331 (852–1767) | 1390 (952–1779) | 503 (70–1642) | 0.01 |
* Statistical tests performed: Wilcoxon rank-sum test; chi-square test of independence; Fisher’s exact test.
Abbreviations used: SD, standard deviation; HIV, human immunodeficiency virus; ART, anti-retroviral therapy; TBM, tuberculous meningitis; CNS, central nervous system; MRI, magnetic resonance imaging; CT, computed tomography; CXR, chest X-ray; LTFU, lost to follow up; ATT, anti-tuberculosis therapy; CSF, cerebrospinal fluid; WCC, white cell count; Mtb, Mycobacterium tuberculosis.
1. Defined by the Uniform Tuberculous Meningitis Research Case Definition Criteria.