Open AccessClinical Outcome of Tuberculous Meningitis with Hydrocephalus — A Retrospective Study
Author(s) -
Davendran Kanesen,
Regunath Kandasamy,
Albert Wong Sii Hieng,
John Tharakan,
Lim Chien Joo,
Jafri Malin Abdullah
Publication year - 2021
Publication title -
the malaysian journal of medical sciences/the malaysian journal of medical science
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.394
H-Index - 25
eISSN - 2180-4303
pISSN - 1394-195X
DOI - 10.21315/mjms2021.28.5.8
Subject(s) - medicine , glasgow coma scale , tuberculous meningitis , hydrocephalus , retrospective cohort study , hazard ratio , tuberculosis , medical record , surgery , glasgow outcome scale , proportional hazards model , meningitis , pediatrics , confidence interval , pathology
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.