Clinical course, complications and predictors of mortality in patients with tuberculous meningitis--an experience of fifty two cases at Civil Hospital Karachi, Pakistan

Abstract

Objective: To assess the clinical course, complications and predictors of mortality in reducing the consequent morbidity and mortality in patients with tuberculous meningitis.

Methods: A prospective study was carried out at Civil Hospital Karachi from January 2009 to January 2011. Fifty-two confirmed cases of tuberculous meningitis were included. The entire clinical course with complications and predictors of mortality were assessed. Data was analyzed using SPSS version 17.0.

Results: The mean age of the patients was 36.29 +/- 16.7 years with an equal gender distribution. The presenting complaints were fever 51 (98.1%), neck-stiffness 44 (84.61%), and altered level of consciousness 40 (76.9%), headache 31 (59.6%), vomiting 19 (36.5%) and focal weakness 10 (19.2%). Among CNS signs, 47 (90.4%) patients had signs of meningeal irritation, 14 (26.9%) had cranial nerve palsies with abducent nerve being the most commonly involved cranial nerve (25%). Mean GCS was 11.4 +/- 2.9 and most of the patients presented with medical research council Stage 2 of tuberculous meningitis (which is minimally altered level of consciousness with minor focal neurological signs). Overall mortality was 21.1%. Univariate analysis revealed old age; advanced stage of tuberculous meningitis, serum sodium < 125 mmol/l, TLC > 9000/microL development of hydrocephalus and use of mechanical ventilation as major predictors of mortality.

Conclusion: Tuberculous meningitis is a frequently reported problem in our part of the world. Hydrocephalus along with other sequelae are common complications. All patients should be assessed for the presence of risk factors affecting mortality of the disease.