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Meta-Analysis
. 2025 May-Jun;20(7-9):559-571.
doi: 10.1080/17460913.2024.2366604. Epub 2024 Oct 3.

Systematic review of tuberculous meningitis in high-risk populations: mortality and diagnostic disparities

Andressa Lorena Ieque  1 , Carolina Trevisolli Palomo  1 , Deborah de Castro Moreira  1 , Jean Eduardo Meneguello  2 , Letícia Sayuri Murase  2 , Lincoln Luís Silva  2 , Vanessa Pietrowski Baldin  2 , Katiany Rizzieri Caleffi-Ferracioli  2   3 , Vera Lucia Dias Siqueira  2   3 , Rosilene Fressatti Cardoso  1   2   3 , Jorge Juarez Vieira Teixeira  1   2   3 , Regiane Bertin De Lima Scodro  1   3
Affiliations
Meta-Analysis

Systematic review of tuberculous meningitis in high-risk populations: mortality and diagnostic disparities

Andressa Lorena Ieque et al. Future Microbiol. 2025 May-Jun.

Abstract

Aim: Tuberculous meningitis (TBM) is one of the most severe clinical forms of tuberculosis (TB). Since epidemiological studies can contribute to TB control, we conducted a review and meta-analysis of epidemiological publications of adults TBM cases in countries with high incidence of TB.Materials & methods: The search resulted in 11,855 articles, in which 21 ultimately were included in our review and 15 in our meta-analysis.Results: TBM mortality was 25% with death rates of 70% in Africa. The review showed different and non-concordant diagnostic techniques and treatment schemes.Conclusion: Adults living in the African region are at high risk of death from TBM, highlighting an urgent need of guidelines to support diagnosis and treatment, and ultimately, to reduce mortality.

Keywords: Mycobacterium tuberculosis; diagnostic; meningitis; mortality; prevalence; treatment.

Plain language summary

Tuberculosis (TB) is a disease that mostly affects the lungs. It can also affect other organs. When TB affects the brain and spinal cord, it is called tuberculous meningitis (TBM). We looked to analyze the traits of the adults with TBM that live in countries with a high number of cases of TB. We searched scientific publications that studied these populations to find information that may help to control the disease. The death rate of TBM was 25%, reaching up to 70% in Africa. We found some disparities regarding diagnosis and treatment. Adults living in Africa have a higher risk of dying from TBM. We need guidelines about the diagnosis and treatment of TBM to help reduce TBM deaths in these countries.

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Conflict of interest statement

The authors have no competing interests or relevant affiliations with any organization or entity with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Figures

Figure 1.
Figure 1.
Flowchart of publications researched, sorted and included in the systematic review and meta-analysis.
Figure 2.
Figure 2.
Forest plot of the prevalence rate of TBM cases/CNS cases and the pooled prevalence, according to random effects analysis. CI: Confidence interval; weight (%); CNS: Central nervous system; ES: Effect size; TBM: Tuberculous meningitis.
Figure 3.
Figure 3.
Forest plot of the prevalence rate of TBM mortality/TBM cases and the pooled prevalence, according to random effects analysis. CI: Confidence interval; weight (%); ES: Effect size; TBM: Tuberculous meningitis.
Figure 4.
Figure 4.
Forest plot of the prevalence rate of TBM mortality/Meningitis cases and the pooled prevalence, according to random effects analysis. CI: Confidence interval, weight (%); ES: Effect size; Menin: Meningitis; TBM: Tuberculous meningitis.
See this image and copyright information in PMC

References

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