title: Culture positive tuberculous meningitis: clinical indicators of poor prognosis.
abstract: Few studies have evaluated culture positive tuberculous meningitis (TBM) as a group. We evaluated certain clinical factors in culture positive TBM which could be associated with a poorer outcome. Out of 40 consecutive TBM patients seen over a period of 4 years in a tertiary referral hospital, 18 culture positive and non-human immunodeficiency virus (HIV) related cases were studied. The mean age was 37.9 +/- 14.9 years (range 9-63); five were males and 13 females. None had any associated active chronic medical illness. Patients (44.4%) started on antituberculous treatment within 24 h of admission. Treatment was initiated at a median time of 48 h upon admission in hospital. Univariate analysis revealed a significant correlation between hydrocephalus (P = 0.007) and poor morbidity and mortality. The other clinical factors were not statistically significant: age (P = 0.36): sex (P = 0.49); symptom duration (P = 0.69); BCG vaccination (P = 0.65); cerebral infarct (P = 0.63); extrameningeal spread (P = 1.00); steroids (P = 1.00); time to treatment (P = 0.94) and stage of disease (P = 0.11). Hydrocephalus was the only significant factor predisposing culture positive TBM patients to a poorer outcome. There was also a trend towards a poorer prognosis in those with advanced stage of the disease.
authors.affiliation: Department of Neurology, Singapore General Hospital, Singapore. ek12@aol.com
authors.forename: E K
authors.initials: EK
authors.lastname: Tan
authors.forename: M W
authors.initials: MW
authors.lastname: Chee
authors.forename: L L
authors.initials: LL
authors.lastname: Chan
authors.forename: Y L
authors.initials: YL
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D000995:Antitubercular Agents / Q000627:therapeutic use; D002648:Child; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D011379:Prognosis; D016896:Treatment Outcome; D014390:Tuberculosis, Meningeal / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology
chemical_list: D000995:Antitubercular Agents