Afazel Samin, Nasiri Mohammad J, Venketaraman Vishwanath
Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA, 91766-1854, USA.
New Microbes New Infect. 2025 Aug 21;67:101623. doi: 10.1016/j.nmni.2025.101623. eCollection 2025 Oct.
Tuberculous meningitis (TBM) remains a leading cause of mortality and neurological disability in both children and adults. This systematic review and meta-analysis aim to assess the treatment outcomes of anti-tuberculosis drugs in TBM patients, focusing on mortality and neurological disability.
We conducted a comprehensive literature search on PubMed/MEDLINE, EMBASE, and Cochrane CENTRAL databases to identify articles reporting treatment outcomes in TBM up to December 15, 2024. Studies included in the analysis reported treatment outcomes for TBM patients. Pooled analyses were performed using random-effects model to assess mortality rates, neurological disability, and loss to follow-up.
A total of 10 studies involving 2005 patients were included in the analysis. The pooled all-cause mortality rate across studies was 27.7 % (95 % CI: 22.6-33.4 %, : 76 %), with higher mortality observed in HIV-positive individuals (40.3 %) compared to HIV-negative patients (17.1 %). The pooled rate of loss to follow-up was 6.6 % (95 % CI: 4.7-9.1 %). Subgroup analysis revealed that the mortality rate increased from 18.9 % at 3 months to 29.1 % at 6 months. The frequency of neurological disability was higher among studies using the Modified Rankin Scale (41.7 %) compared to the Barthel Index (14.1 %).
This study highlights the high mortality and significant neurological disability in TBM patients, particularly in HIV-positive individuals. Our findings emphasize the need for standardized outcome reporting and the incorporation of new therapeutic strategies, and improved diagnostic tools, to enhance clinical outcomes. Future research should focus on addressing these areas to optimize treatment protocols and reduce the burden of TBM.
结核性脑膜炎（TBM）仍然是儿童和成人死亡及神经功能残疾的主要原因。本系统评价和荟萃分析旨在评估抗结核药物治疗TBM患者的疗效，重点关注死亡率和神经功能残疾情况。
我们在PubMed/MEDLINE、EMBASE和Cochrane CENTRAL数据库中进行了全面的文献检索，以识别截至2024年12月15日报告TBM治疗结果的文章。纳入分析的研究报告了TBM患者的治疗结果。采用随机效应模型进行汇总分析，以评估死亡率、神经功能残疾率和失访率。
共有10项研究涉及2005例患者纳入分析。各研究的汇总全因死亡率为27.7%（95%CI：22.6 - 33.4%，I²：76%），与HIV阴性患者（17.1%）相比，HIV阳性个体的死亡率更高（40.3%）。汇总失访率为6.6%（95%CI：4.7 - 9.1%）。亚组分析显示，死亡率从3个月时的18.9%升至6个月时的29.1%。与巴氏指数（14.1%）相比，使用改良Rankin量表的研究中神经功能残疾的发生率更高（41.7%）。
本研究突出了TBM患者，尤其是HIV阳性个体的高死亡率和显著的神经功能残疾。我们的研究结果强调了标准化结局报告的必要性，以及纳入新的治疗策略和改进诊断工具以改善临床结局的必要性。未来的研究应专注于解决这些领域，以优化治疗方案并减轻TBM的负担。
