Incidence, risk factors and treatment of central nervous system immune reconstitution inflammatory syndrome in non‐HIV patients with tuberculous meningitis: a multicentre observational study

Abstract

AbstractBackgroundImmune reconstitution inflammatory syndrome (IRIS) affecting the central nervous system (CNS) is associated with poor outcomes.AimsTo report on risk factors for CNS‐IRIS following tuberculous meningitis (TBM) in HIV‐negative patients.MethodsIn this retrospective multicentre study, all HIV‐negative adult patients admitted between 2003 and 2021 with microbiologically proven TBM were included. The primary outcome measure was IRIS onset over follow‐up. Characteristics of patients who developed IRIS were described. Factors associated with IRIS were identified using a multivariable logistic regression procedure.ResultsFifty‐six patients (33.0 (27.0–44.3) years, 39 (69.6%) men) with microbiologically proven TBM were studied. All patients received antituberculosis treatment and 48 (n = 48/56; 85.7%) steroids at TBM diagnosis. During a median follow‐up of 18.0 (12.0–27.3) months, IRIS occurred in 28 (n = 28/56, 50.0%) patients, at a median time of 2.0 (1.0–3.0) months after antituberculosis treatment was started. IRIS involved the CNS in all but one case. Imaging revealed new (n = 23/28, 82.1%) and/or worsening (n = 21/28; 75.0%) of previously recognised lesions. Multivariable analysis showed that meningeal enhancement on brain magnetic resonance imaging (MRI) (odds ratio (OR): 15.3; 95% confidence interval (CI): (1.19–1193.5)) at TBM diagnosis and high blood albumin level (OR: 1.21; 95% CI: (1.02–1.60)) were associated with the occurrence of CNS‐IRIS during follow‐up.ConclusionCNS‐IRIS following TBM in non‐HIV patients appears frequent and severe. Meningeal enhancement on brain MRI at tuberculosis diagnosis is a risk factor for CNS‐IRIS.