A PROSPECTIVE STUDY ON CLINICAL PROFILE AND OUTCOME OF PATIENTS WITH TUBERCULOUS MENINGITIS AT A TERTIARY CARE CENTRE IN MAHARASHTRA

Abstract

BACKGROUND: Tuberculous meningitis (TBM) is one of the most fatal forms of tuberculosis, early diagnosis and treatment of which can reduce morbidity and mortality. This study was undertaken to achieve data regarding clinical prole and outcome of patients from western India as epidemiological data is lacking from this region. METHODS: This prospective observational study was conducted on 136 patients admitted in medical ward and critical care unit of a tertiary care hospital in Maharashtra over 18 months. Clinical, biochemical, radiological and microbiological evaluation was done. Data was analyzed using SPSS 22 version software and p value of <0.05 as signicant. RESULTS: The mean age of cases was 35.2 ± 14.69 years, majority from age group of 18 - 40 years. Out of 136 cases, 62 (45.6%) were males and 74 (54.4%) females. Commonest clinical features were fever and headache, followed by altered sensorium and seizure. Symptoms were mostly of acute onset (<14 days). 42 cases (30.9%) were associated with present or past pulmonary tuberculosis and 34 (25%) with retroviral disease. 7 cases (5.2%) had hemiparesis and 3 (2.2%) had ophthalmoplegia. Mean ESR was 56.59 + 22.87. CSF showed lymphocytosis (mean 88.4 + 18.09 %), low glucose percentage (mean 39.57 + 0.2 %) and high protein (mean 146.02 + 106.62 mg/dl). 117 cases (86%) showed positive neuroimaging. Outcome was poor in stage III disease. CONCLUSION: Tuberculous meningitis usually presents as acute onset illness with fever, headache or altered sensorium. CSF Gene Xpert has low sensitivity as compared to neuroimaging. Advanced disease was associated with poor outcome.