Predictors for outcome and treatment delay in patients with tuberculous meningitis.
BACKGROUND
Tuberculous meningitis (TBM) is a challenge for clinicians because of the difficulty in making an early diagnosis and the severe consequences of delaying treatment. The objective of this study was to assess predictors of outcome and to evaluate factors critical to treatment delay of TBM.


METHODS
One hundred and five adult patients with TBM, between 1997 and 2006, were retrospectively studied. Treatment delay was defined as progression of stage and physician delay between the initial presentation and the start of antituberculosis therapy. Factors contributing to the outcome, progression of stage, and prolonged physician delay were evaluated using univariate and multivariate analyses.


RESULTS
Fifty patients (47.6%) experienced prolonged physician delay, and 38 (36.2%) had progression of stage. Thirty-four patients (32.4%) had an acute clinical course, and 76 (72.4%) received initial antibacterial therapy. Prolonged physician delay and progression of stage were important prognostic factors for poor outcome. Stage I at admission and prolonged physician delay were important factors contributing to progression of stage. An acute clinical course and an initial antibacterial therapy were important factors contributing to prolonged physician delay.


CONCLUSIONS
Rapid diagnosis and early treatment before the occurrence of progression of stage are crucial for the outcome of TBM. TBM may present with an acute course, and when discrimination from bacterial meningitis is difficult, it is mandatory to start antituberculosis and antibacterial therapy simultaneously or lower the threshold for early antituberculosis therapy when persistent fever, deteriorated consciousness status, or progression of stage occurs during antibacterial therapy.
Sheu
Jau-Jiuan
JJ
Department of Neurology, Taipei Medical University Hospital, 252 Wu-Hsing Street, Taipei, Taiwan. jjs2239@tmu.edu.tw
Yuan
Rey-Yue
RY
Yang
Chih-Chao
CC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome; D014390:Tuberculosis, Meningeal / Q000134:cerebrospinal fluid / Q000188:drug therapy*
D000995:Antitubercular Agents