Study of Clinical Correlates of Tubercular Meningitis in a Tertiary Care Centre in Moradabad
DOI:
https://doi.org/10.48165/ma07hy92Keywords:
Tubercular Meningitis, HIV, CSFAbstract
Background: Tuberculosis continues to remain a leading cause of mortality worldwide with tubercular meningitis being the most common type of central nervous system tuberculosis that is associated with significant morbidity and mortality if not identified and treated promptly. Due to meager amount of published data and lack of evaluation of the western UP population, this study was conducted in order to observe a detailed clinical course of the disease as well as to analyze predictors of morbidity and mortality in patients of TBM admitted at a tertiary care hospital in Moradabad.Subjects and Methods: A total of 120 patients with diagnosis of TBM as per the diagnostic criteria of the study were included and all their information and features recorded and treatment done as per guidelines and a follow-up done at 3 months using Barthel Index.Results: Multivariate logistic regression analysis of various factors revealed age of the patient (p=0.04), duration of symptoms (p=0.002), stage of TBM on presentation (p=0.001), TLC>9000 (p=0.006), low CSF glucose (p=0.01), hyponatremia (p=0.04), hypoalbuminemia (p=0.007) and hydrocephalus (p=0.04) on neuroimaging were significant risk factors of mortality and morbidity in adult patients of TBM.Conclusion: The current study may provide components for the composition of a score to predict outcome using the significant poor prognostic factors that were recognized in this study. This can be utilised for prompt employment of rigorous management remedies in order to reduce patients’ morbidity and mortality.
References
1. TB disease burden. Global Tuberculosis Report. © World Health Organization 2019: Chapter3:P.No.27. https://apps.who.int/iris/bitstream/handle/10665/329368/978924156571 4-eng.pdf?ua=1 [Accessed 6th December 2019]
2. Gu J, Xiao H, Wu F, Ge Y, Ma J, Sun W. Prognostic factors of tuberculous meningitis: a single-center study. Int J ClinExp Med 2015;8:4487-93.
3. Girgis N I,Sultan Y, Farid Z. Tuberculous meningitis, Abbassia Fever Hospital—U.S. Naval Medical Research Unit No. 3—Cairo, Egypt, from 1976 to 1996. Am J Trop Med Hyg 1998;58:28-34.
4. Rock RB, Hu S, Gekker G. Mycobacterium tuberculosis-induced cytokine and chemokine expression by human microglia and astrocytes: effects of dexamethasone. J Infect Dis 2005;192:2054–8.
5. Verdon R, Chevret S, Laissy JP, Wolff M. Tuberculous meningitis in adults review of 48 cases. Clin Infect Dis 1996;22,982–8.
6. Kent SJ, Crowe SM, Yung A, Lucas CR, Mijch AM. Tuberculous meningitis: a 30-year review. Clin Infect Dis 1993;17:987-94. 7. Bidstrup C, Andersen PH, Skinhøj P, Andersen AB. Tuberculous meningitis in a country with a low incidence of tuberculosis: still a serious disease and a diagnostic challenge. Scandinavian J Infect Dis 2002;34:811–4.
8. Council MR. Streptomycin treatment of pulmonary tuberculosis. British Medical Journal. 1948 Oct;2:769-82.
9. Misra UK et al. A study of hyponatremia in tuberculous meningitis. J NeurolSci .2016;367:152–7
10. Po-Chang H, Chien CY, Jung Jr Y, Po-Yen H, Ping CC, Ming HL. Prognostic factors of tuberculous meningitis in adults: a 6-year retrospective study at a tertiary hospital in Northern Taiwan. J MicrobiolImmunol Infect 2010; 43:111-8.
11. Kaur H, Sharma K, Modi M, Sharma A, Rana S, Khandelwal N, et al. Prospective analysis of 55 cases of tuberculosis meningitis (TBM) in North India. J ClinDiag Res 2015; 9:15-9.
12. Salekeen S, Mahmood K, Naqvi H. et al. Clinical course, complications and predictors of mortality in patients with tuberculous meningitis — an experience of fifty two cases at Civil Hospital Karachi, Pakistan JPMA.2013;63:563.
13. Sabbatani S. Historical insights into tuberculosis. GirolamoFracastoro's intuition on the transmission of tuberculosis and his opponents. History of an idea. Infez Med. 2004;12(4):284–291.
14. O'Connor TM. Reference Module in Biomedical Sciences, from International Encyclopedia of Public Health. New York, NY: Elsevier; 2008. Tuberculosis: overview; pp. 408–414.
15. Gupta R et al. Predictors of adverse outcome in patients of tuberculous meningitis in a multi-centric study from India. Indian J Tuberc. 2017;185:1-6.
16. Abbas A et al. Visual Impairment in HIV Negative Tuberculosis Meningitis. J Meningitis 2015;1:1
17. Verdon R, Chevret S, Laissy JP, Wolff M. Tuberculous meningitis in adults review of 48 cases. Clin Infect Dis 1996;22,982–8.
18. Erdem, H., Ozturk-Engin, D., Tireli, H et al. Hamsi scoring in the prediction of unfavorable outcomes from tuberculous meningitis: results of Haydarpasa-II study. Journal of Neurology 2015; 262:890-898.
19. Po-Chang H, Chien CY, Jung Jr Y, Po-Yen H, Ping CC, Ming HL. Prognostic factors of tuberculous meningitis in adults: a 6-year retrospective study at a tertiary hospital in Northern Taiwan. J MicrobiolImmunol Infect 2010; 43:111-8.
20. Thwaites GE, Duc Bang N, Huy Dung N, ThiQuy H, ThiTuongOanh D, Thi Cam Thoa N, et al. The influence of HIV infection on clinical presentation, response to treatment, and outcome in adults with Tuberculosis meningitis. J Infect Dis.2005; 192:2134-41.
21. Ingole R, Garg RK, Malhotra HS, Jain A, Kumar N, Rizvi I, Garg R. Spectrum of central nervous system tuberculosis: An experience from a large tertiary care institution of India. Indian Journal of Tuberculosis. 2017 Jun 16.
22. Li, K., Tang, H., Yang, Y., Li, Q., Zhou, Y., Ren, M., Long, X., Shen, W., Hu, R., Wang, X. and Zeng, K. Clinical features, long-term clinical outcomes, and prognostic factors of tuberculous meningitis in West China: a multivariate analysis of 154 adults. 2017.
23. Christensen AS, Andersen AB, Thomsen VO, Andersen PH, Johansen IS Tuberculosis meningitis in Denmark: a review of 50 cases. BMC Infect Dis. 2011;11:47.
24. Gambhir IS, Mehta M, Singh DS, Khanna HD. Evaluation of CSF adenosine deaminase activity in tubercular meningitis. J Assoc Physicians India. 1999; 47:192-94.
25. Lee SW, Kang YA, Yoon YS, Um S, Lee SM, Yoo C, et al. The Prevalence and Evolution of Anemia Associated with Tuberculosis. J Korean Med Sci 2006; 21: 1028-32.
26. Cotton MF, Donald PR, Schoeman JF, Aalbers C, Van Zyl LE, Lombard C. Plasma arginine vasopressin and the syndrome of inappropriate antidiuretic hormone secretion in tuberculous meningitis, Pediatr. Infect. Dis. J. 1991;10:837-2.
27. Singh BS, Patwari AK, Deb M. Serum sodium and osmolal changes in tuberculous meningitis, Indian Pediatr. 1994; 31:1345-50. 28. Christopher R, Gourie-Devi M. The syndrome of inappropriate antidiuretic hormone secretion in tuberculous meningitis, J. Assoc. Physicians India.1997;45: 933–5.
29. Patwari AK, Singh BS, Manorama DE, Inappropriate secretion of antidiuretic hormone in acute bacterial meningitis, Ann. Trop. Paediatr. 1995;15: 179–183.
30. Kee CP, Periyasamy P, Law ZK, Ibrahim NM, Features and Prognostic Factors of Tuberculous Meningitis in a Tertiary Hospital in Malaysia J Infect Dis Epidemiol 2017, 3:028.
31. Davis LE, Rastogi KR, Lambert LC, Skipper BJ. Tuberculous meningitis in the southwest United States: a community based study. Neurology 1993;43:1775–8.
32. Berger JR. Tuberculous meningitis. CurrOpinNeurol 1994;7:191–200.