Criteria indicating morbidity in tuberculous meningitis.

OBJECTIVE

To work out a criterion that may indicate morbidity in tuberculous meningitis.

METHODS

The retrospective study was conducted at the Medical Unit of the Liaquat University of Health Sciences, Jamshoro, Pakistan, and included cases related to a period between January 2006 and June 2011. Record of 50 patients were evaluated for clinical features, chest radiograph, Mantoux test, sputum for acid fast bacilli, routine investigations, cerebrospinal fluid studies, computerised tomography scan and magnetic resonance imaging of head. All the patients in the study had been treated with conventional approach. The severity of the condition was classified in stages, I, II and III. Clinical features, laboratory findings and imaging reports were analysed through SPSS 10 to find out the criteria indicating morbidity. Mean, median, standard deviation were calculated. Student t-test was applied on variables.

RESULTS

Of the 50 patients, 26 (52%) were male and 24 (48%) were female. Their ages ranged from 12 to 70 years. Mean age was 37.72 +/-19.65 years. Median age was 35.54 years. Of the total, 17 (34%) patients recovered completely without any complications. Their mean age was 24+/-8.98 years and their mean time interval from onset of illness to presentation in the hospital was 21.75+/-9.75 days. Besides, 30 (60%) patients persisted with neurological sequelae, including cranial nerve palsies, hemiplegia, and hydrocephalus. Patients with neurological sequelae had mean age of 48+/-17.48 years and their mean time interval from onset of illness to presentation in the hospital was 41.33+/-14.14 days. Hydrocephalus was seen in 10 (20%) patients. Three (6%) patients expired. Clinical features, laboratory findings and imaging reports analysis showed that the criteria indicating morbidity were increasing age of the patient (p=0.037), late diagnosis (p=0.044), advancing stage of disease, and development of hydrocephalus.

CONCLUSION

Increasing age of the patient, late diagnosis, advancing stage of the disease and the development of hydrocephalus indicate morbidity in tuberculous meningitis.