Complications of tuberculous meningitis and their effect on outcome in a tertiary care cohort
U. K. Misra, Jayantee Kalita, Manoj Kumar, Abhilasha Tripathi, Prabhakar Mishra
Abstract
BACKGROUND: To report the frequency and severity of complications, and their effect on the outcome of tuberculous meningitis (TBM). METHODS: In this retrospective cohort study, the following TBM complications were observed: status epilepticus (SE), hydrocephalus, paradoxical clinical worsening (PCW), hyponatremia, drug-induced hepatitis (DIH), infarction and mechanical ventilation (MV). These were recorded and correlated with stage of meningitis and outcome. RESULTS: A total of 144 patients with TBM (median age 26 years, range 12–75) were included. There were 76 (52.8%) females. The patients were in Stage I ( n = 33), Stage II ( n = 82) and Stage III ( n = 29); 58 had definite TBM. Complications occurred in 128 (88.9%); complications included hydrocephalus ( n = 58, 40.3%), hyponatremia ( n = 70, 48.6%), infarction ( n = 48, 33.3%), DIH ( n = 42, 29.2%), SE ( n = 16, 18.0%), MV ( n = 43, 29.9%) and PCW ( n = 24, 16.7%), with variable overlap. By 6 months, 33 patients had died. Death was related to PCW ( P = 0.016), hyponatremia ( P = 0.03), MV ( P = 0.02), infarction ( P = 0.03) and the number of complications. Except PCW, most complications occurred during the first month. CONCLUSIONS: In TBM, complications occurred in 128 (88.9%) patients, mainly in the early stages, with variable overlap. Infarction, PCW, hyponatremia and MV were predictive of poor outcome.