Clinical Profile of Tuberculous Meningitis in Kashmir Valley-The Indian Subcontinent

Abstract

Background: Tuberculosis is a global issue and 2 billion people are infected out of which 1.3 billion come from developing world and tuberculous meningitis (TBM) complicates 1 of every 300 untreated primary tuberculosis infections. Diagnosis is still difficult especially in developing and resource poor countries. We conducted the study to see the clinical profile and the use of available diagnostic tools in the early diagnosis of TBM in our part of the world. Methods: Sixty-eight patients were enrolled and only 38 followed for a period of 3 years from hospitalization to completion of treatment and for sequelae in a tertiary care hospital of Kashmir valley India. Clinical presentation, use of available diagnostic tools, treatment, outcome, and sequelae were studied with the aim to find helpful available tools in early diagnosis and management of TBM. Results: Only 38 patients completed the follow-up and important results were that 29 patients (76.31%) belonged to rural areas, 21 (55.26) were in the age group 20 to 39 years, 60% were females. Relation between stage at presentation, early treatment and outcome, useful laboratory investigations, cerebrospinal fluid (CSF) analysis, computed tomography scan findings, usefulness of serum and CSF enzyme-linked immunoabsorbent assay, most effective treatment regimen, sequelae and mortality were some of the important results obtained. Conclusions: Tuberculous meningitis was found to be more common in female rural population of the valley. Erythrocyte sedimentation rate, CSF analysis, serum and CSF enzyme-linked immunoabsorbent assay, computed tomography scan were the most useful diagnostic tools to support clinical suspicion. Combination 4 drug antitubercular regimen for 12 months was the most effective and steroids improved the outcome in stages II and III of the disease. Mortality was higher in very severe disease, at extremes of age and delay in initiating treatment.