title: Prognosis of tuberculous meningitis in adults in the era of modern antituberculous chemotherapy.
abstract: This study reviewed the clinical manifestations and outcome of tuberculous meningitis in the era of modern antituberculous chemotherapy and applied these data in assessing the role of clinical staging evaluated 30 days after treatment in predicting long-term outcome. A total of 41 adult patients with tuberculous meningitis hospitalized at a university hospital in Taiwan from June 1994 through August 1999 were included in this retrospective study. Their age ranged from 16 to 80 years (median, 41 years), and 17 (41.5%) patients had had a variety of underlying immunocompromising diseases. Fever (90%), headache (75.6%), neck stiffness (68.3%), altered consciousness (26.8%), and nausea and/or vomiting (26.8%) were the leading initial presentations. During the treatment course, 19 patients experienced new neurologic complications. The overall case fatality rate was 9.8% and morbidity rate 56.1%. More advanced clinical stage evaluated at 30 days after initiation of antituberculous chemotherapy and positive cerebrospinal fluid culture for Mycobacterium tuberculosis were the only 2 factors significantly associated with a worse long-term prognosis. Results indicate that tuberculous meningitis is associated with a high morbidity, consisting of minor and major neurologic sequelae, despite modern antituberculous chemotherapy. In addition, more advanced clinical staging evaluated at 30 days after the start of antituberculous chemotherapy and a positive cerebrospinal fluid culture for M. tuberculosis were associated with a poor prognosis.
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC.
authors.forename: Jann-Tay
authors.initials: JT
authors.lastname: Wang
authors.forename: Chien-Ching
authors.initials: CC
authors.lastname: Hung
authors.forename: Wang-Huei
authors.initials: WH
authors.lastname: Sheng
authors.forename: Jann-Yuan
authors.initials: JY
authors.lastname: Wang
authors.forename: Shan-Chwen
authors.initials: SC
authors.lastname: Chang
authors.forename: Kwen-Tay
authors.initials: KT
authors.lastname: Luh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004977:Ethambutol / Q000627:therapeutic use; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007538:Isoniazid / Q000627:therapeutic use; D007958:Leukocyte Count; D008297:Male; D009169:Mycobacterium tuberculosis / Q000472:pathogenicity; D011379:Prognosis; D011718:Pyrazinamide / Q000627:therapeutic use; D012293:Rifampin / Q000627:therapeutic use; D013307:Streptomycin / Q000627:therapeutic use; D016896:Treatment Outcome; D014390:Tuberculosis, Meningeal / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality
chemical_list: D000995:Antitubercular Agents; D011718:Pyrazinamide; D004977:Ethambutol; D007538:Isoniazid; D012293:Rifampin; D013307:Streptomycin