Long-Term Clinical Outcome of Tubercular Meningitis Patients after Short Course Chemotherapy: A Prospective Study

  • Mohammad Salem Baba Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
  • Mohammad Maqbol Wani Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
  • Tehmeena Wani Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
  • Suhail Jeelani Shah Vector control research centre (ICMR), Puducherry, India
Keywords: Anti-tubercular therapy, Grade, Outcome, Mortality, Tuberculosis, Tubercular meningitis

Abstract

Background: Tuberculosis (TB) is a global epidemic affecting humans since ages. Tubercular meningitis (TBM) is the most severe form of TB with high rates of mortality and severe disability. Treatment recommendations range from 6 months to 18 months. The current study was aimed to assess the long-term outcome of TBM patients after short course chemotherapy. Methods: A prospective study was conducted at a tertiary care hospital and included 72 cases of TBM, diagnosis based on consensus criteria for TBM. Patients were divided into three grades based on disease severity. Grade 1 received 6 months of ATT and Grades 2 and 3, 9 months. Clinical outcome was assessed at 9 months and at 36 months using modified Rankin scale. Various predictors of mortality were assessed by univariate and multivariate analysis. Results: 20 patients (27.8%) were classified as Grade 1, 33 patients as Grade 2 (45.8%) and 19 patients as Grade 3 (26.4%). At 9 months follow-up, a total of 21 patients (29.1%) died, severe disability occurred in 13 patients (18.0%), 10 patients recovered with minor neurological deficits (13.9%), and 28 patients recovered completely (38.9%). At 36 months of follow-up, a total of 33 patients (45.8%) recovered completely, 7 patients (9.7%) had minor neurological deficits, 7 patients (9.7%) had severe disability, and 25 patients (34.7%) died. On univariate analysis, statistically significant predictors of poor outcome included: Grade of TBM (P = 0.001), Glasgow coma scale (GCS) <11(P = 0.0001), presence of neurological deficit at presentation (P = 0.003), seizures (P = 0.014), presence of papilledema (P = 0.005), imaging evidence of hydrocephalus/infarct/tuberculoma and meningeal enhancement (P = 0.001). However, in multivariate analysis, GCS<11 at presentation (P = 0.004), advanced grade of the disease (P = 0.02), presence of neurological deficit (P = 0.01), and imaging evidence of basal meningeal enhancement/ tuberculomas/hydrocephalus/infarct (P = 0.019) were associated with poor outcome. Conclusion: TBM is a disease with high mortality and severe disability. Short course chemotherapy regimens do not worsen the long-term outcome

Author Biographies

Mohammad Salem Baba, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India

Senior Resident, Department of Internal Medicine, 

Mohammad Maqbol Wani, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India

Additional Professor, Department of Neurology,

Tehmeena Wani, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India

Additional Professor, Department of Microbiology,

Suhail Jeelani Shah, Vector control research centre (ICMR), Puducherry, India

Ph. D Scholar, Division of Vector Ecology & Surveillance, 

Published
2015-09-30
Section
Table of Contents