Outcome of Hydrocephalus in Tuberculous Meningitis. A Retrospective Study (original) (raw)
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Clinical Outcome of Tuberculous Meningitis with Hydrocephalus — A Retrospective Study
The Malaysian Journal of Medical Science, 2021
Background: To study the clinical outcome of tuberculous meningitis with hydrocephalus (TBMH) and the factors contributing to its poor clinical outcome. Methods: Clinical data of 143 adult patients diagnosed with TBM over a 6-year period in two tertiary hospitals in Malaysia were retrospectively reviewed. Relevant clinical and radiological data were studied. Patients with TBMH were further analysed based on their clinical grade and rendered treatment to identify associated factors and outcome of this subgroup of patients. The functional outcome of patients was assessed at 12 months from treatment. Results: The mean age of patients was 35.6 (12.4) years old, with a male gender predominance of 67.1%. Forty-four percent had TBMH, of which 42.9% had surgical intervention. In the good modified Vellore grade, 76.5% was managed medically with concurrent antituberculosis treatment (ATT), steroids and osmotic agents. Four patients had surgery early in the disease as they did not respond to medical therapy and reported a good outcome subsequently. Poor outcome (65.2%) was seen in the poor modified Vellore grade despite medical and surgical intervention. Multivariate model multiple Cox regression showed significant results for seizure (adjusted hazard ratio [aHR]: 15.05; 95% CI: 3.73, 60.78), Glasgow coma scale (GCS) (aHR: 0.79; 95% CI: 0.70, 0.89) and cerebrospinal fluid (CSF) cell count (aHR: 1.11; 95% CI: 1.05, 1.17). Conclusion: Hydrocephalus was seen in 44% of patients in this study. GCS score, seizure and high CSF cell count were factors associated with a poor prognosis in TBM. Patients with TBMH treated medically (TBMHM) had better survival function compared to TBMH patients undergoing surgical intervention (TBMHS) (P-value < 0.001). This retrospective study emphasises that TBMH is still a serious illness as 47.6% of the patients had poor outcome despite adequate treatment.
Pakistan Journal of Medical and Health Sciences, 2021
Aim: To determine the prevalence of hydrocephalus is in tuberculous bacterial meningitis patients Study Design: Cross sectional study Place and duration: This study was conducted in Pakistan Institute of Medical Sciences Islamabad, Pakistan From September 2019 to December 2020 Methodology: The technique of nonprobability, sequential sampling, was used. After a thorough examination, patients with tuberculous bacterial meningitis (TBM) were included. At the time of admission, a brief history of socio-demographics and the length of the illness was taken. The proforma was filled up with the results. The data were analyzed using SPSS Version 22. Results: Out of 120 patients, males made up 59.16 % cases. The age groups 20-30 years, 31-40 years, 41-50 years, and 51-60 years were represented in the study by 28 (23.33 %), 37 (30.83%), 17 (14.16 %), and 38 (31.66%) patients, respectively. The prevalence of hydrocephalus among TBM was 16.66%, with the 20-30 year age group having the most cases...
Features and Prognostic Factors of Tuberculous Meningitis in a Tertiary Hospital in Malaysia
Journal of Infectious Diseases and Epidemiology
Tuberculous meningitis (TBM) has been one of the major extrapulmonary manifestation with high morbidity and mortality. This paper aims to study the clinical features, prognostic factors and clinical outcome of TBM in a local tertiary hospital. This was an observational study on TBM in patients who were diagnosed in a local tertiary hospital. The patients' demographic data, medical history, clinical presentation at admission, radiological and microbiological data was reviewed along with the clinical course, treatment and outcome. Sixty one patients were recruited with 37 (60.7%) males and 24 (39.3%) females, with the mean age of 47.4 (SD 18.165). The main presenting features were fever (55.7%), headache (78.7%) and altered conscious level (78.7%). The most common imaging finding was hydrocephalus (43.3% in CT brain and 26.2% in MRI brain), followed by leptomeningeal enhancement (20% in CT brain and 42.9% in MRI brain) and infarct (21.7% in CT brain, 35.7% in MRI brain). The median total antitubercular therapy which patients received was 336 (IQR 332) days. There were 86.9% patients who survived the hospital admission, while 70.5% survived the 6 months follow-up period. Factors associated with poor prognosis were intubation on presentation, surgical intervention (either ventricular-peritoneal shunting or external ventricular drain), elevated CSF protein and presence of tuberculoma in cerebral imaging. This study highlights the importance of recognizing the clinical features and prognostic factors in TBM. A high index of clinical suspicion should always be maintained and supported by cerebrospinal fluid analysis and radiological features.
Hydrocephalus Caused by Tuberculous Meningitis in an Immunocompetent Young Adult: A Case Report
International Medical Case Reports Journal
Background: Despite improved medical management, meningeal tuberculosis mortality and other outcomes have changed slightly over time due to a delay in diagnosis and treatment. This study reports a rare case of tuberculous meningitis in an immunocompetent host, calling into question the commonly held belief that tuberculous meningitis is a disease of immunocompromised individuals. Case Presentation: A 26-year-old male with no significant past medical history, tuberculosis, or indications of immunological compromise, was admitted to our hospital with a fever and altered mental status. He was drowsy, febrile (temperature of 38°C), had a heart rate of 110 beats per minute, and showed mild neck stiffness but no meningeal sign. A lumbar puncture on the third day of admission suggested tuberculous meningitis. He was treated for tuberculosis meningitis, and his condition slightly improved. However, the patient's condition suddenly worsened, and a repeat contrast computed tomography (CT) of the brain showed the development of ventriculomegaly and basilar enhancement. Insertion of an emergency ventriculoperitoneal shunt was performed; however, the patient died ten days after hospital admission. Conclusion: We report a fatal case of tuberculous meningitis in an immunocompetent patient. Healthcare practitioners must be trained to identify and diagnose tuberculous meningitis promptly. Early treatment of tuberculous meningitis based on clinical diagnosis and symptoms improves clinical outcomes.
Tuberculosis Meningitis (TBM) and Hydrocephalus
2019
Objectives: To determine the frequency of cases detected with hydrocephalus in cases presenting with TBM. Material & methods; This cross sectional study was conducted during July to December 2018 at Surraya Azeem Hospital, Lahore & Aziz Bhatti Shaheed teaching hospital, Gujrat. The detailed demographic data was collected. The cases of TBM were selected on clinical and laboratory diagnosis and then they underwent CT scan of brain (plain) and diagnosis of TBM was made in BMRC scale. Results; In this study, 300 cases of TBM were selected and, out of these 180 (60%) were males and 120 (40%) females with mean age of 43.11±9.13 years. There were 18 (6%) cases in stage I, 195 (65%) in II and 57 (29%) in stage III of TBM. Hydrocephalus was observed in 144 (48%) of the cases. There was no significant difference in terms of gender and age groups with p values of 0.67 and 0.58. The results were significantly higher in those that had stage III of TBM where it was see in 57 (65.52%) out of 87 ca...
International Journal of Integrated Health Sciences
Objective: To describe the clinical characteristics and complications observed in tuberculous meningitis (TBM) patients with hydrocephalus who had undergone fluid diversion management. Methods: This was a cross-sectional descriptive observational study involving 28 TBM patients with hydrocephalus aged 0-5 years who had undergone ventriculoperitoneal shunt or extraventricular drainage in the period of July 2011 to July 2016 in Dr. Hasan Sadikin General Hospital, Bandung. Age, gender, head circumferences, nutritional status, and classical characteristics such as sunset eye, frontal bossing, cracked pot sign, venectation as well as complications such as infection, phlebitis, and exposed shunt documented in the hospital medical records were analyzed. Results: The study discovered that infant group was predominant (21/28). Some of the patients had macrocephalus (7/28) and 18 had good nutrition status (18/28). There were 4 patients with frontal bossing characteristics (4/28) and almost none was found with others classic hydrocephalus characteristics. This study found no complication such as infection, phlebitis, and exposed shunt in TBM patients with hydrocephalus who had undergone fluid diversion therapy in Dr. Hasan Sadikin General Hospital, Bandung. Conclusions: One of the most dominan characteristics of TBM patients with hydrocephalus is frontal bossing. Tuberculous meningitis patients with hydrocephalus in our center did not show any fluid diversion-related complications such as infection, phlebitis, or exposed shunt.
PAFMJ, 2021
Objective: To assess the clinical profile and outcome of patients admitted with the diagnosis of tuberculous meningitis (TBM) at neurology unit of a tertiary care teaching hospital of Pakistan. Study Design: Cross-sectional study. Place and Duration of Study: Neurology department, Pak Emirates Military Hospital Rawalpindi, from Dec 2018 to Jun 2019. Methodology: This study was conducted on 69 patients of tuberculous meningitis admitted. Demographic profile included age, gender, and the symptoms with which the patient presented. Neurological complications were also documented among the target population. Outcomes included recovery, shifting to intensive care unit and death. Results: A total of 69 patients admitted in neurology ward diagnosed and managed as tuberculous meningitis in the study duration time. Male to female ratio was 1.4:1. Mean age of patients diagnosed with tuberculous meningitis in our study was 34.23 ± 3.915 years. Most of the patients presented with the fever follo...
Journal of Microbiology, Immunology and Infection, 2010
BACKGROUND/PURPOSE: To investigate the clinical features, laboratory test results, imaging data, and prognostic predictors of tuberculous meningitis (TBM) in adults. METHODS: We retrospectively reviewed 108 adult patients with a diagnosis of TBM over a 6-year period. Patients were divided into "definite" and "probable" groups, depending on the diagnosis made by (1) positive culture, or polymerase chain reaction, of Mycobacterium tuberculosis (TB) from the cerebrospinal fluid (CSF); or (2) the isolation of TB elsewhere, or chest radiography consistent with active pulmonary TB, or imaging studies of the brain consistent with TBM, or clinical improvement on treatment. These two groups were compared for their clinical features, images, laboratory test results, and 9-month mortality rates to identify prognostic predictors. RESULTS: Compared with the "probable" group (n = 62), the "definite" group (n = 46) had a higher mortality rate (50.0% vs. 30.6%, p = 0.041) and more consciousness disturbance (78.3% vs. 51.6%, p = 0.005), hydrocephalus (63.4% vs. 40.7%, p = 0.029) and isolation of TB from extra-CSF specimens (41.3% vs. 22.6%, p = 0.037). Old age (p = 0.002), consciousness change (p = 0.032), and hydrocephalus (p = 0.047) were poor prognostic indicators in the "definite" group as assessed by univariate analysis. Severity of TBM at admission and delayed anti-TB therapy resulted in a poor prognosis for all patients. Multiple logistic regression analysis showed that old age and hydrocephalus were independent factors for mortality. Adjunctive steroid therapy over 2 weeks improved survival in both the "definite" (p = 0.002) and "probable" (p = 0.035) groups, but more than 4 weeks of use had no significant effect on mortality. Steroid treatment, therefore, may improve the outcome of patients with TBM.