title: Clinical Features and Outcome in Adult Cases of Tuberculous Meningitis in Tertiary Care Hospital in Antananarivo, Madagascar.
abstract: Purpose.We aimed to describe and to assess prognosis factors in tuberculous meningitis in adult patients.Methods.We performed a retrospective study of case records of adult patients. Patients classified as definite, probable, or possible tuberculous meningitis according to standardized definition criteria were included and assessed in the study.Results.Seventy-five patients were included in the study. Tuberculous meningitis was classified as definite in 8 (10.7%), probable in 44 (58.7%), and possible in 23 patients (30.6%). HIV was found in 3% of patients. Patients were in advanced stages at admission in 82.7%. Median duration of symptoms prior to admission was 3 weeks (IQR: 2-5). Median time to diagnosis following admission was 5 days (IQR: 3-8). Median CSF WCC was 75 per mm3with lymphocytic predominance in 38 cases (52.8%). Median CSF glucose level was 1.48 mmol/L and median CSF protein level was 1 g/L. Mortality rate was 28%. Age ≥ 35 years (aOR: 4.06; 95% CI: 1.16-14.26) and coma (aOR: 12.98; 95% CI: 1.13-149.16) predicted inpatient mortality.Conclusion.Most of the patients experienced more than 3 weeks of diagnostic delay prior to admission. Mortality was high and occurred early after admission. Age and coma were identified as independent prognosis factors.
authors.affiliation: Service des Maladies Infectieuses, Hôpital Universitaire Joseph Raseta Befelatanana, Antananarivo, Madagascar.
authors.forename: Mihaja
authors.identifier: 0000-0001-8857-5834
authors.initials: M
authors.lastname: Raberahona
authors.affiliation: Service des Maladies Infectieuses, CHU Tambohobe, Fianarantsoa, Madagascar; Université de Fianarantsoa, Fianarantsoa, Madagascar.
authors.forename: Rivonirina Andry
authors.initials: RA
authors.lastname: Rakotoarivelo
authors.affiliation: Service des Maladies Infectieuses, Hôpital Universitaire Joseph Raseta Befelatanana, Antananarivo, Madagascar.
authors.forename: Tiana
authors.initials: T
authors.lastname: Razafinambinintsoa
authors.affiliation: Service des Maladies Infectieuses, Hôpital Universitaire Joseph Raseta Befelatanana, Antananarivo, Madagascar; Programme National de Lutte contre la Tuberculose (PNLT), Ministère de la Santé Publique, Antananarivo, Madagascar.
authors.forename: Radonirina Lazasoa
authors.initials: RL
authors.lastname: Andrianasolo
authors.affiliation: Service des Maladies Infectieuses, Hôpital Universitaire Joseph Raseta Befelatanana, Antananarivo, Madagascar.
authors.forename: Mamy Jean de Dieu
authors.initials: MJ
authors.lastname: Randria
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D044383:Black People; D057210:Delayed Diagnosis; D005260:Female; D006801:Humans; D008270:Madagascar; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification / Q000472:pathogenicity; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D014390:Tuberculosis, Meningeal / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000453:epidemiology* / Q000382:microbiology