Prospective Analysis of 55 Cases of Tuberculosis Meningitis (TBM) in North India.
BACKGROUND
To assess the clinical profile, laboratory and neuroimaging data of adult tuberculous meningitis (TBM) patients and to determine the predictors of mortality.


METHODS
A total of 55 TBM patients and 60 controls were enrolled in this prospective study. Detailed clinical, radiological, biochemical and microbiological evaluation was performed.


METHODS
Done using SPSS 15.0 for Windows. P value of <0.05 was considered to be significant.


RESULTS
61.8% were males and majority of the study subjects belonged to age group of 21-40 years. Duration of symptoms in all cases was >14 days and commonly included fever, headache, neck rigidity, altered sensorium and vomiting. Biochemical features of cerebrospinal fluid (CSF) showed significant results where 94.5%, 85.45%,83.63% and 81.81% of patients showed CSF sugar levels <2/3 corresponding blood sugar, proteins>100mg%, CSF total leucocyte count of >20 cells/mm(3) and ADA >9.5IU/L respectively while neuroimaging revealed hydrocephalus, basal exudates and meningeal enhancement as significant findings. More than half of TBM patients presented in stage II of disease and overall mortality was 43.63%. A model for prediction of mortality in TBM cases was framed which included variables of age>40 years, past history of tuberculosis (TB), presence of basal exudates and hydrocephalus.


CONCLUSIONS
TBM is a serious extrapulmonary form of TB and should arise suspicion in mind of clinician based on clinical, laboratory and radiologic results. Further, a model for prediction of mortality in such patients may be helpful for early intervention and better prognosis.
Senior Resident, Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research , Sector 12, Chandigarh, India .
Harsimran
H
Kaur
Associate Professor, Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research , Sector 12, Chandigarh, India .
Kusum
K
Sharma
Assistant Professor, Department of Neurology, Postgraduate Institute of Medical Education and Research , Sector 12, Chandigarh, India .
Manish
M
Modi
Assistant Professor, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research , Sector 12, Chandigarh, India .
Aman
A
Sharma
Professor, Department of Gastroenterology, Postgraduate Institute of Medical Education and Research , Sector 12, Chandigarh, India .
Satyawati
S
Rana
Professor and Head, Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research , Sector 12, Chandigarh, India .
Niranjan
N
Khandelwal
Professor and Head, Department of Neurology, Postgraduate Institute of Medical Education and Research , Sector 12, Chandigarh, India .
Sudesh
S
Prabhakar
Professor and Head, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research , Sector 12, Chandigarh, India .
Subhash
S
Varma
Clinical; India; Laboratory parameters; Neuroimaging; Predictors of mortality; Tuberculous meningitis