Raberahona Mihaja, Rakotoarivelo Rivonirina Andry, Razafinambinintsoa Tiana, Andrianasolo Radonirina Lazasoa, Randria Mamy Jean de Dieu
Service des Maladies Infectieuses, Hôpital Universitaire Joseph Raseta Befelatanana, Antananarivo, Madagascar.
Service des Maladies Infectieuses, CHU Tambohobe, Fianarantsoa, Madagascar; Université de Fianarantsoa, Fianarantsoa, Madagascar.
Biomed Res Int. 2017;2017:9316589. doi: 10.1155/2017/9316589. Epub 2017 Mar 15.
We aimed to describe and to assess prognosis factors in tuberculous meningitis in adult patients. We performed a retrospective study of case records of adult patients. Patients classified as definite, probable, or possible tuberculous meningitis according to standardized definition criteria were included and assessed in the study. Seventy-five patients were included in the study. Tuberculous meningitis was classified as definite in 8 (10.7%), probable in 44 (58.7%), and possible in 23 patients (30.6%). HIV was found in 3% of patients. Patients were in advanced stages at admission in 82.7%. Median duration of symptoms prior to admission was 3 weeks (IQR: 2-5). Median time to diagnosis following admission was 5 days (IQR: 3-8). Median CSF WCC was 75 per mm with lymphocytic predominance in 38 cases (52.8%). Median CSF glucose level was 1.48 mmol/L and median CSF protein level was 1 g/L. Mortality rate was 28%. Age ≥ 35 years (aOR: 4.06; 95% CI: 1.16-14.26) and coma (aOR: 12.98; 95% CI: 1.13-149.16) predicted inpatient mortality. Most of the patients experienced more than 3 weeks of diagnostic delay prior to admission. Mortality was high and occurred early after admission. Age and coma were identified as independent prognosis factors.
我们旨在描述并评估成年结核性脑膜炎患者的预后因素。我们对成年患者的病例记录进行了回顾性研究。根据标准化定义标准被分类为确诊、很可能或可能结核性脑膜炎的患者被纳入本研究并进行评估。本研究纳入了75例患者。结核性脑膜炎被分类为确诊8例（10.7%），很可能44例（58.7%），可能23例（30.6%）。3%的患者检测出HIV。82.7%的患者入院时处于晚期。入院前症状的中位持续时间为3周（四分位间距：2 - 5周）。入院后至诊断的中位时间为5天（四分位间距：3 - 8天）。脑脊液白细胞计数中位数为每立方毫米75个，38例（52.8%）以淋巴细胞为主。脑脊液葡萄糖水平中位数为1.48 mmol/L，脑脊液蛋白水平中位数为1 g/L。死亡率为28%。年龄≥35岁（调整后比值比：4.06；95%置信区间：1.16 - 14.26）和昏迷（调整后比值比：12.98；95%置信区间：1.13 - 149.16）可预测住院死亡率。大多数患者在入院前经历了超过3周的诊断延迟。死亡率很高且在入院后早期出现。年龄和昏迷被确定为独立的预后因素。
