Tuberculous meningitis in adults: review of 61 cases.
BACKGROUND
Tuberculosis is still a major cause of serious illness in developing countries. The objective of this study was to assess the clinical, laboratory, radiological and prognostic features of tuberculous meningitis (TBM) in immuncompetent adult patients.


METHODS
Sixty-one patients with confirmed or presumed TBM seen over a 12-year period at the Neurology Department of Bakirköy Research and Training Hospital for Psychiatric and Neurological Disease, Istanbul, Turkey, were analyzed retrospectively. Patients were grouped according to the severity of meningitis on admission (stages I, II and III). They were also divided into two groups according to the presence of paradoxical response (progressive increase of lymphocytes or increase of polymorphonuclear cells instead of lymphocytes) in CSF samples. A combination of five antituberculosis drugs was used in the 1st month of treatment. Patients received antituberculosis therapy for at least 12 months. The outcome of the patients was defined on the basis of the 12-month Barthel index (BI) score (BI < 12 poor; BI >/= 12 good). For statistical analysis death was included in the poor outcome group.


RESULTS
Paradoxical response in CSF findings was seen in 20 patients. There was no statistically significant difference between the outcome of the patients with and without CSF paradoxical response; however, new tuberculomas developed more frequently in the first group (p < 0.05). The overall mortality was 27.8%. Stage of disease was found to be independently associated with the 12-month outcome (OR 7.2; 95% CI 1.7-30.3, p = 0.007).


CONCLUSIONS
In developing countries such as Turkey, tuberculosis is still an important public health issue. Early suspicion and appropriate long-term antituberculosis therapy together with corticosteroids may reduce mortality and morbidity in TBM patients.
Sütlaş
P N
PN
Dept. of Neurology, Bakirköy Research and Training Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey.
Unal
A
A
Forta
H
H
Senol
S
S
Kirbaş
D
D
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D016017:Odds Ratio; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D014390:Tuberculosis, Meningeal / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D014421:Turkey / Q000453:epidemiology
D000995:Antitubercular Agents