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Meta-Analysis
. 2023 Feb 16;18(2):e0279203.
doi: 10.1371/journal.pone.0279203. eCollection 2023.

Microbiological diagnosis and mortality of tuberculosis meningitis: Systematic review and meta-analysis

Getachew Seid  1   2 , Ayinalem Alemu  1   2 , Biniyam Dagne  1   2 , Dinka Fekadu Gamtesa  1
Affiliations
Meta-Analysis

Microbiological diagnosis and mortality of tuberculosis meningitis: Systematic review and meta-analysis

Getachew Seid et al. PLoS One. .

Abstract

Background: Tuberculosis (TB) which is caused by Mycobacterium tuberculosis poses a significant public health global treat. Tuberculosis meningitis (TBM) accounts for approximately 1% of all active TB cases. The diagnosis of Tuberculosis meningitis is notably difficult due to its rapid onset, nonspecific symptoms, and the difficulty of detecting Mycobacterium tuberculosis in cerebrospinal fluid (CSF). In 2019, 78,200 adults died of TB meningitis. This study aimed to assess the microbiological diagnosis TB meningitis using CSF and estimated the risk of death from TBM.

Methods: Relevant electronic databases and gray literature sources were searched for studies that reported presumed TBM patients. The quality of included studies was assessed using the Joanna Briggs Institute Critical Appraisal tools designed for prevalence studies. Data were summarized using Microsoft excel ver 16. The proportion of culture confirmed TBM, prevalence of drug resistance and risk of death were calculated using the random-effect model. Stata version 16.0 was used perform the statistical analysis. Moreover, subgroup analysis was conducted.

Results: After systematic searching and quality assessment, 31 studies were included in the final analysis. Ninety percent of the included studies were retrospective studies in design. The overall pooled estimates of CSF culture positive TBM was 29.72% (95% CI; 21.42-38.02). The pooled prevalence of MDR-TB among culture positive TBM cases was 5.19% (95% CI; 3.12-7.25). While, the proportion of INH mono-resistance was 9.37% (95% CI; 7.03-11.71). The pooled estimate of case fatality rate among confirmed TBM cases was 20.42% (95%CI; 14.81-26.03). Based on sub group analysis, the pooled case fatality rate among HIV positive and HIV negative TBM individuals was 53.39% (95%CI; 40.55-66.24) and 21.65% (95%CI;4.27-39.03) respectively.

Conclusion: Definite diagnosis of TBM still remains global treat. Microbiological confirmation of TBM is not always achievable. Early microbiological confirmation of TBM has great importance to reduce mortality. There was high rate of MDR-TB among confirmed TBM patients. All TB meningitis isolates should be cultured and drug susceptibility tested using standard techniques.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow diagram of systematic search of studies for this systematic review and meta-analysis.
Fig 2
Fig 2. CSF Culture confirmed Tuberculosis meningitis among suspected patients.
Fig 3
Fig 3. ZN AFB microscopy positivity of CSF in TBM suspected patients.
Fig 4
Fig 4. Pooled estimate of MDR-TB prevalence in Tuberculosis confirmed isolates.
Fig 5
Fig 5. Prevalence of INH mono resistance in Tuberculosis meningitis confirmed isolates.
Fig 6
Fig 6. Mortality among Tuberculosis meningitis suspected patients.
See this image and copyright information in PMC

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