Clinical, Imaging, and Laboratory Characteristics of Adult Mexican Patients with Tuberculous Meningitis: A Retrospective Cohort Study

Abstract

Tuberculous Meningitis (TBM) is the infection of the meninges by Mycobacterium tuberculosis (Mtb) [1]. First described by Green in 1836 [2], TBM is the most common form of central nervous system tuberculosis (TB), accounting for 5-6% of extrapulmonary TB cases and for 1% of the total TB cases worldwide [1,3,4]. TBM is described as a subacute illness with a duration of symptoms that ranges 5-30 days with clinical features such as a low-grade fever, headache, and signs of meningeal irritation; in advanced stages, there may be focal neurological deficits, cranial nerve paralysis, and seizures [1,5,6]. The global incidence of TBM is unknown [7]; in 2017, Mexico had an overall prevalence of 0.35 cases per 100,000 inhabitants [8]. The global HIV epidemic has increased the number of adults affected by TBM. Data from a study that included a database of 1699 adult patients from five different studies reported a mortality rate of 23% in non-HIV patients and 51.3% for HIV-infected patients [9], reaching 100% in cases of drug-resistant Mtb [3]. Despite its high incidence, to our knowledge, the clinical features and outcome of the Mexican adult population with TBM have not been described. The aim of this study is to describe the characteristics at admission and in-hospital outcome of adult Mexican patients with TBM and compare them according to the subtype of diagnosis.

Tuberculous meningitis in adult patients of a Mexican neurological referral center: A-six-year retrospective cohort study

“…According to TB risk factors, HIV and diabetes are the main described in the literature (13) but others such as drugs abuse, and alcoholism are important. In a Mexican cohort study in Tijuana, Baja California includes 41 TB patients, in which 51% were drug users, and 27% of alcoholics (14). This data contrasted with our series where only 10% were drug users while 52% alcoholics.…”

“…In this series a cohort of 41 adult patients was reported. The median age was 28-years old and mortality of 19.5% (14). In a Vietnam cohort study of 1699 TBM patients, it was reported that 951 were non-HIV infected and were 748 HIV-positive, in this cohort the mortality at 9-months was 35%, and the more common predictors for increased mortality were the higher stage of Medical Research Council and the lower CSF lymphocyte cell count (22).…”

“…Median glycorrhachia was 47 mg/dL (ranges 18-64), proteinorachia 95 mg/dL (44-188) and cellularity 53.5 cells/mm 3 (6-195). Th median CSF adenosine deaminase level was 7 UI/L (3-14). No differences were observed between groups.…”

“…In this series a cohort of 41 adult patients was reported. The median age was 28-years old and mortality of 19.5% (14).…”

Central nervous system tuberculosis

“…CSF and urine lipoarabinomannan (LAM) are very specific yet had low sensitivity for TBM diagnosis in a cohort of mainly HIV-infected TBM patients in Zambia [15]. Circumstantial evidence may be provided by chest radiography, which identifies pulmonary abnormalities in 30–50% of patients with TBM [16,17]. Brain imaging may be improved by three-dimensional (3D) magnetization-prepared rapid gradient-echo (MP-RAGE) MRI, which has improved sensitivity due to its use of thin slices (1 mm), thereby detecting more brain lesions [18 ▪▪ ].…”