Yasemin Cag1, Derya Ozturk-Engin2, Serap Gencer3, Rodrigo Hasbun4, Gonul Sengoz5, Alexandru Crisan6, Nurgul Ceran2, Branislava Savic7, Kadriye Yasar8, Filiz Pehlivanoglu5, Gamze Kilicoglu2, Hulya Tireli2, Ayse S Inal9, Rok Civljak10, Recep Tekin11, Nazif Elaldi12, Aysegul Ulu-Kilic13, Muge Ozguler14, Mustafa Namiduru15, Mustafa Sunbul16, Oguz R Sipahi17, Olga Dulovic16, Selma Alabay13, Ayhan Akbulut14, Alper Sener18, Botond Lakatos19, Katell Andre20, Mucahit Yemisen21, Serkan Oncu22, Mihai Nechifor23, Ozcan Deveci11, Seniha Senbayrak2, Asuman Inan2, Gorana Dragovac24, Hanefi C G L25, Gurkan Mert25, Oral Oncul26, Bahar Kandemir27, Serpil Erol2, Canan Agalar28, Hakan Erdem25. 1. Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey. 2. Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey. 3. Department of Infectious Diseases and Clinical Microbiology, Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey. 4. Department of Infectious Diseases, Medical School, The University of Texas Health Science Center at Houston, USA. 5. Department of Infectious Diseases and Clinical Microbiology, Haseki Training and Research Hospital, Istanbul, Turkey. 6. Department of Infectious Diseases, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania. 7. Faculty of Medicine, National Reference Laboratory for Tuberculosis, Institute of Microbiology and Immunology, University of Belgrade, Belgrade, Serbia. 8. Department of Infectious Diseases and Clinical Microbiology, Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey. 9. Department of Infectious Diseases and Clinical Microbiology, Cukurova University School of Medicine, Adana, Turkey. 10. Department of Infectious Diseases, Dr. Fran Mihaljevic University Hospital for Infectious Diseases, University of Zagreb School of Medicine, Zagreb, Croatia. 11. Department of Infectious Diseases and Clinical Microbiology, Dicle University School of Medicine, Diyarbakir, Turkey. 12. Department of Infectious Diseases and Clinical Microbiology, Cumhuriyet University School of Medicine, Sivas, Turkey. 13. Department of Infectious Diseases and Clinical Microbiology, Erciyes University School of Medicine, Kayseri, Turkey. 14. Department of Infectious Diseases and Clinical Microbiology, Firat University School of Medicine, Elazig, Turkey. 15. Department of Infectious Diseases and Clinical Microbiology, Gaziantep University School of Medicine, Gaziantep, Turkey. 16. Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University School of Medicine, Samsun, Turkey. 17. Department of Infectious Diseases and Clinical Microbiology, Ege University School of Medicine, Izmir, Turkey. 18. Department of Infectious Diseases and Clinical Microbiology, Onsekiz Mart University School of Medicine, Canakkale, Turkey. 19. Department of Infectious Diseases, Saint Laszlo Hospital, Budapest, Hungary. 20. Department of Infectious Diseases, Dax Hospital, France. 21. Department of Infectious Diseases and Clinical Microbiology, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey. 22. Department of Infectious Diseases and Clinical Microbiology, Adnan Menderes University School of Medicine, Aydin, Turkey. 23. Department of Infectious Diseases, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania. 24. Department of Prevention and Control of Diseases, Medical Faculty, IPH of Vojvodina, University of Novi Sad, Serbia. 25. Department of Infectious Diseases and Clinical Microbiology, Gulhane Medical Academy, Ankara, Turkey. 26. Istanbul Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul University, Istanbul, Turkey. 27. Department of Infectious Diseases and Clinical Microbiology, Necmettin Erbakan University School of Medicine, Konya, Turkey. 28. Department of Infectious Diseases and Clinical Microbiology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey.
Abstract
AIMS: 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. MATERIALS AND 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.
AIMS: 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. MATERIALS AND 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.
Authors: Joseph Donovan; Ursula K Rohlwink; Elizabeth W Tucker; Nguyen Thi Thu Hiep; Guy E Thwaites; Anthony A Figaji Journal: Wellcome Open Res Date: 2019-10-31