Abstract
BackgroundTuberculous meningitis is the most devastating presentation of disease with Mycobacterium tuberculosis. We sought to evaluate treatment outcomes for adult patients with this disease.MethodsThe Ovid MEDLINE, EMBASE, Cochrane Library and Web of Science databases were searched to identify all relevant studies. We pooled appropriate data to estimate treatment outcomes at the end of treatment and follow-up.ResultsAmong the articles identified, 22 met our inclusion criteria, with 2437 patients. In a pooled analysis, the risk of death was 24.7% (95%CI: 18.7–31.9). The risk of neurological sequelae among survivors was 50.9% (95%CI: 40.2–61.5). Patients diagnosed in stage III or human immunodeficiency virus (HIV) positive were significantly more likely to die (64.8, 53.4% respectively) during treatment. The frequency of cerebrospinal fluid (CSF) acid-fast-bacilli smear positivity was 10.0% (95% CI 5.5–17.6), 23.8% (15.2–35.3) for CSF culture positivity, and 22.3% (17.8–27.5) for CSF polymerase chain reaction positivity. We found that the headache, fever, vomiting, and abnormal chest radiograph were the most common symptoms and diagnostic findings among tuberculous meningitis patients.ConclusionsDespite anti-tuberculosis treatment, adult tuberculous meningitis has very poor outcomes. The mortality rate of patients diagnosed in stage III or HIV co-infection increased significantly during treatment.
Highlights
Tuberculous meningitis is the most devastating presentation of disease with Mycobacterium tuberculosis
Tuberculous meningitis is especially common in children and those infected with human immunodeficiency virus (HIV), in whom outcomes are poor [2, 5]
The findings suggested that the treatment outcomes for adult patients with tuberculous meningitis are poor
Summary
Tuberculous meningitis is the most devastating presentation of disease with Mycobacterium tuberculosis. We sought to evaluate treatment outcomes for adult patients with this disease. Tuberculosis, caused by Mycobacterium tuberculosis (MTB), remains one of the leading causes of infectionrelated mortality worldwide [1]. Tuberculous meningitis is the most devastating presentation of disease with MTB [2], which accounts for approximately 1% of all cases of active tuberculosis, and 5 to 10% of extra-pulmonary tuberculosis cases [3, 4]. Prompt anti-tuberculosis treatment and corticosteroids are the main determinants of outcome in tuberculous meningitis [2]. Since identification of acid-fast bacilli in the cerebrospinal fluid (CSF) and culture of MTB lack sensitivity, the diagnosis of tuberculous meningitis is often based on clinical suspicion combined with empirical decision making [3]. With the introduction of the Glasgow Coma Scale (GCS) [7], this was
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