Prediction of stroke (infarction) post tuberculous meningitis using biomarkers (CSF cytokines and interleukins)

Abstract

Tuberculous meningitis (TBM) is a devastating form of Mycobacterium Tuberculosis infection. According to the World Health Organization (WHO, 2012),the annual incidence of tuberculosis is 8.7 million worldwide, of which the major brunt being borne by the developing countries. In India, the estimated mortality due to TBM is 1.5/100,000 population.8% of strokes in the young in India have been attributed to TB vasculopathy. Based on Modified British Research Council clinical criteria patients were categorized into 3 stages. Stage I: prodromal phase with no definite neurological symptoms, GCS 15/15. (12 patients) Stage II: slight or no clouding of sensorium and minor or no neurological deficits, GCS between11-14. (35 patients) Stage III: severe clouding of sensorium, focal neurological deficits, GCS ≤ 10.(33 patients) Interim analysis was done calculating the mean and SD. Total 80 samples were analyzed out of 96 (N=96; of which 16 expired). ELISA-Assay was run for all the samples. Development of infarction persists to be dreadful complication of tuberculosis meningitis. Patients with TBM having low Glasgow coma scale score on presentation and presence of exudates have a significantly high risk for development of infarction. Development of infarction was found to have significant disability as well as high mortality as compared to those without infarction.