Predictors for outcome and treatment delay in patients with tuberculous meningitis
Journal
American Journal of the Medical Sciences
Journal Volume
338
Journal Issue
2
Pages
134-139
ISSN
0002-9629
Date Issued
2009-08
Author(s)
Abstract
BACKGROUND: Tuberculous meningitis (TBM) is a challenge for clinicians because of the difficulty in making an early diagnosis and the severe consequences of delaying treatment. The objective of this study was to assess predictors of outcome and to evaluate factors critical to treatment delay of TBM. METHODS: One hundred and five adult patients with TBM, between 1997 and 2006, were retrospectively studied. Treatment delay was defined as progression of stage and physician delay between the initial presentation and the start of antituberculosis therapy. Factors contributing to the outcome, progression of stage, and prolonged physician delay were evaluated using univariate and multivariate analyses. RESULTS: Fifty patients (47.6%) experienced prolonged physician delay, and 38 (36.2%) had progression of stage. Thirty-four patients (32.4%) had an acute clinical course, and 76 (72.4%) received initial antibacterial therapy. Prolonged physician delay and progression of stage were important prognostic factors for poor outcome. Stage I at admission and prolonged physician delay were important factors contributing to progression of stage. An acute clinical course and an initial antibacterial therapy were important factors contributing to prolonged physician delay. CONCLUSIONS: Rapid diagnosis and early treatment before the occurrence of progression of stage are crucial for the outcome of TBM. TBM may present with an acute course, and when discrimination from bacterial meningitis is difficult, it is mandatory to start antituberculosis and antibacterial therapy simultaneously or lower the threshold for early antituberculosis therapy when persistent fever, deteriorated consciousness status, or progression of stage occurs during antibacterial therapy. ? Copyright 2009 Southern Society for Clinical Investigation.
Subjects
Outcome; Treatment delay; Tuberculous meningitis
Other Subjects
antibiotic agent; tuberculostatic agent; adult; aged; antibiotic therapy; article; consciousness level; controlled study; disease course; fever; human; major clinical study; Mycobacterium tuberculosis; outcome assessment; physician; predictor variable; prognosis; retrospective study; therapy delay; tuberculous meningitis
Type
journal article