INTRODUCTION: Tuberculous meningitis (TBM), a tuberculous infection of the leptomeninges, carries significant morbidity and mortality. To date, little literature is available regarding TBM in Pakistan. METHODS: All adult patients with TBM admitted to a tertiary care teaching hospital in Karachi, were reviewed retrospectively. AIMS: To describe the demographic profile, clinical features, laboratory and radiological picture of these patients and to identify predictors of mortality. RESULTS: Among the 190 patients analyzed, majority (28%) were between 21-30 years of age. Fever (90%), impaired consciousness (63%) and nausea/vomiting (50%) were the most common presenting symptoms. Thirty four percent were categorized as clinical stage III. CSF cultures were positive in only 5%. Thirty seven percent had an associated lung pathology on a chest X-ray. Neuroimaging revealed meningeal enhancement in 27% and hydrocephalus in 23%. All patients were treated with antituberculous therapy; 79% received concomitant steroid therapy. Neurosurgical intervention was required in 13% and mechanical ventilation support in 12%. Overall mortality was 20% and neurological sequelae were seen in 42% of the survivors. Univariate analysis showed age greater than sixty years, clinical stage III and mechanical ventilation as predictors of mortality. The logistic regression model, however, revealed that stage III presentation was not an independent predictor. CONCLUSION: We continue to see late presentations of TBM in our setting. The current study has shown that age greater than sixty years and the need for mechanical ventilation are significant independent predictors of mortality.
INTRODUCTION:Tuberculous meningitis (TBM), a tuberculous infection of the leptomeninges, carries significant morbidity and mortality. To date, little literature is available regarding TBM in Pakistan. METHODS: All adult patients with TBM admitted to a tertiary care teaching hospital in Karachi, were reviewed retrospectively. AIMS: To describe the demographic profile, clinical features, laboratory and radiological picture of these patients and to identify predictors of mortality. RESULTS: Among the 190 patients analyzed, majority (28%) were between 21-30 years of age. Fever (90%), impaired consciousness (63%) and nausea/vomiting (50%) were the most common presenting symptoms. Thirty four percent were categorized as clinical stage III. CSF cultures were positive in only 5%. Thirty seven percent had an associated lung pathology on a chest X-ray. Neuroimaging revealed meningeal enhancement in 27% and hydrocephalus in 23%. All patients were treated with antituberculous therapy; 79% received concomitant steroid therapy. Neurosurgical intervention was required in 13% and mechanical ventilation support in 12%. Overall mortality was 20% and neurological sequelae were seen in 42% of the survivors. Univariate analysis showed age greater than sixty years, clinical stage III and mechanical ventilation as predictors of mortality. The logistic regression model, however, revealed that stage III presentation was not an independent predictor. CONCLUSION: We continue to see late presentations of TBM in our setting. The current study has shown that age greater than sixty years and the need for mechanical ventilation are significant independent predictors of mortality.