Hydrocephalus and vasculitis delay therapeutic responses in tuberculous meninigitis: Results of Haydarpasa-III study.
OBJECTIVE
There is no report on the factors affecting the resolution of symptoms related to meningitis during treatment of tuberculous meningitis (TBM). Thus, we examined the factors associated with early therapeutic responses.


METHODS
This multicenter study included 507 patients with microbiologically confirmed TBM. However, 94 patients eligible for the analysis were included in this study from 24 centers. Six out of 94 patients died and the statistical analysis was performed with 88 survivors. Early and late responder groups were compared in the statistical analysis. P < 0.05 were considered to show a significant difference.


RESULTS
In the multivariate analysis, the presence of vasculitis (P = 0.029, OR = 10.491 [95% CI, 1.27-86.83]) was found to be significantly associated with a delayed fever response whereas hydrocephalus was associated with altered mental status for >9 days duration (P = 0.005, OR = 5.740 [95% CI, 1.68-19.57]). According to linear regression analysis, fever was significantly persisting (>7 days) in the presence of vasculitis (17.5 vs. 7, P< 0.001) and hydrocephalus (11 vs. 7, P = 0.029). Hydrocephalus was significantly associated with persisting headache (21 vs. 12, P = 0.025), delayed recovery of consciousness (19.5 vs. 7, P = 0.001), and a delay in complete recovery (21 vs. 14, P = 0.007) in the linear regression analysis. Following institution of treatment, the complaints seemed to disappear in up to 2 weeks among TBM survivors.


CONCLUSIONS
In the absence of hydrocephalus or vasculitis, one week of anti-tuberculosis treatment seems to be adequate for the resolution of TBM symptoms. Hydrocephalus and vasculitis delay the resolution of TBM symptoms in response to antimycobacterial treatment.
Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey.
Yasemin
Y
Cag
Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey.
Derya
D
Ozturk-Engin
Department of Infectious Diseases and Clinical Microbiology, Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey.
Serap
S
Gencer
Department of Infectious Diseases, Medical School, The University of Texas Health Science Center at Houston, USA.
Rodrigo
R
Hasbun
Department of Infectious Diseases and Clinical Microbiology, Haseki Training and Research Hospital, Istanbul, Turkey.
Gonul
G
Sengoz
Department of Infectious Diseases, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania.
Alexandru
A
Crisan
Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey.
Nurgul
N
Ceran
Faculty of Medicine, National Reference Laboratory for Tuberculosis, Institute of Microbiology and Immunology, University of Belgrade, Belgrade, Serbia.
Branislava
B
Savic
Department of Infectious Diseases and Clinical Microbiology, Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
Kadriye
K
Yasar
Department of Infectious Diseases and Clinical Microbiology, Haseki Training and Research Hospital, Istanbul, Turkey.
Filiz
F
Pehlivanoglu
Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey.
Gamze
G
Kilicoglu
Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey.
Hulya
H
Tireli
Department of Infectious Diseases and Clinical Microbiology, Cukurova University School of Medicine, Adana, Turkey.
Ayse S
AS
Inal
Department of Infectious Diseases, Dr. Fran Mihaljevic University Hospital for Infectious Diseases, University of Zagreb School of Medicine, Zagreb, Croatia.
Rok
R
Civljak
Department of Infectious Diseases and Clinical Microbiology, Dicle University School of Medicine, Diyarbakir, Turkey.
Recep
R
Tekin
Department of Infectious Diseases and Clinical Microbiology, Cumhuriyet University School of Medicine, Sivas, Turkey.
Nazif
N
Elaldi
Department of Infectious Diseases and Clinical Microbiology, Erciyes University School of Medicine, Kayseri, Turkey.
Aysegul
A
Ulu-Kilic
Department of Infectious Diseases and Clinical Microbiology, Firat University School of Medicine, Elazig, Turkey.
Muge
M
Ozguler
Department of Infectious Diseases and Clinical Microbiology, Gaziantep University School of Medicine, Gaziantep, Turkey.
Mustafa
M
Namiduru
Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University School of Medicine, Samsun, Turkey.
Mustafa
M
Sunbul
Department of Infectious Diseases and Clinical Microbiology, Ege University School of Medicine, Izmir, Turkey.
Oguz R
OR
Sipahi
Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University School of Medicine, Samsun, Turkey.
Olga
O
Dulovic
Department of Infectious Diseases and Clinical Microbiology, Erciyes University School of Medicine, Kayseri, Turkey.
Selma
S
Alabay
Department of Infectious Diseases and Clinical Microbiology, Firat University School of Medicine, Elazig, Turkey.
Ayhan
A
Akbulut
Department of Infectious Diseases and Clinical Microbiology, Onsekiz Mart University School of Medicine, Canakkale, Turkey.
Alper
A
Sener
Department of Infectious Diseases, Saint Laszlo Hospital, Budapest, Hungary.
Botond
B
Lakatos
Department of Infectious Diseases, Dax Hospital, France.
Katell
K
Andre
Department of Infectious Diseases and Clinical Microbiology, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey.
Mucahit
M
Yemisen
Department of Infectious Diseases and Clinical Microbiology, Adnan Menderes University School of Medicine, Aydin, Turkey.
Serkan
S
Oncu
Department of Infectious Diseases, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania.
Mihai
M
Nechifor
Department of Infectious Diseases and Clinical Microbiology, Dicle University School of Medicine, Diyarbakir, Turkey.
Ozcan
O
Deveci
Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey.
Seniha
S
Senbayrak
Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey.
Asuman
A
Inan
Department of Prevention and Control of Diseases, Medical Faculty, IPH of Vojvodina, University of Novi Sad, Serbia.
Gorana
G
Dragovac
Department of Infectious Diseases and Clinical Microbiology, Gulhane Medical Academy, Ankara, Turkey.
Hanefi C
HC
G L
Department of Infectious Diseases and Clinical Microbiology, Gulhane Medical Academy, Ankara, Turkey.
Gurkan
G
Mert
Istanbul Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul University, Istanbul, Turkey.
Oral
O
Oncul
Department of Infectious Diseases and Clinical Microbiology, Necmettin Erbakan University School of Medicine, Konya, Turkey.
Bahar
B
Kandemir
Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey.
Serpil
S
Erol
Department of Infectious Diseases and Clinical Microbiology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey.
Canan
C
Agalar
Department of Infectious Diseases and Clinical Microbiology, Gulhane Medical Academy, Ankara, Turkey.
Hakan
H
Erdem
D000995:Antitubercular Agents / Q000627:therapeutic use*; D006801:Humans; D006849:Hydrocephalus / Q000150:complications*; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014390:Tuberculosis, Meningeal / Q000150:complications / Q000188:drug therapy*; D014657:Vasculitis / Q000150:complications*
D000995:Antitubercular Agents