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Neurological complications after tuberculous meningitis in a multi-state cohort in the United States.

TitleNeurological complications after tuberculous meningitis in a multi-state cohort in the United States.
Publication TypeJournal Article
Year of Publication2017
AuthorsMerkler AE, Reynolds AS, Gialdini G, Morris NA, Murthy SB, Thakur K, Kamel H
JournalJ Neurol Sci
Volume375
Pagination460-463
Date Published2017 Apr 15
ISSN1878-5883
KeywordsAdult, Aged, Cohort Studies, Female, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Nervous System Diseases, Proportional Hazards Models, Treatment Outcome, Tuberculosis, Meningeal, United States, Ventriculoperitoneal Shunt, Young Adult
Abstract

BACKGROUND AND PURPOSE: To assess the rate of neurological complications and mortality after tuberculous meningitis in the United States.

METHODS: The authors performed a retrospective cohort study of all patients 18years or older hospitalized for tuberculous meningitis in California between 2005 and 2010, New York between 2006 and 2012, and Florida between 2005 and 2012. Outcomes of interest were mortality and the following neurological complications: stroke, seizure, hydrocephalus requiring a ventriculoperitoneal shunt, vision impairment, and hearing impairment. Kaplan-Meier survival statistics were used to assess the cumulative rate of neurological complications and death. Cox proportional hazards regression was used to compare rates of complications in patients with and without human immunodeficiency virus (HIV) after adjustment for comorbidities.

RESULTS: 806 patients with tuberculous meningitis were identified, among whom the cumulative rate of any complication or death was 55.4% (95% CI, 51.5-59.3%). More than two-thirds of complications occurred during the initial hospitalization for tuberculous meningitis. Individual neurological complications were not uncommon: the cumulative rate of stroke was 16.8% (95% CI, 14.0-20.0%), the rate of seizure was 18.8% (95% CI, 15.4-22.8%), and the rate of ventriculoperitoneal shunting was 8.4% (95% CI, 6.4-10.9%). Vision impairment occurred in 21.6% (95% CI, 18.5-25.1%) of patients and hearing impairment occurred in 6.8% (95% CI, 4.9-9.4%). The mortality rate was 21.5% (95% CI, 18.4-24.9%). Patients with HIV infection were not at increased risk of complications compared to patients without HIV (hazard ratio, 1.2; 95% CI, 0.9-1.6).

CONCLUSIONS: Tuberculous meningitis is associated with significant risk of neurological complications and death in the United States.

DOI10.1016/j.jns.2017.02.051
Alternate JournalJ. Neurol. Sci.
PubMed ID28320186
PubMed Central IDPMC5549847
Grant ListK23 NS082367 / NS / NINDS NIH HHS / United States
R01 HD074944 / HD / NICHD NIH HHS / United States
R01 NS097443 / NS / NINDS NIH HHS / United States