Outcome of Tuberculous Meningitis in Adults

OBJECTIVE: To determine the frequency of mortality and morbidity of TBM patients in our part of world and predictors of mortality. METHODOLOGY: Prospective observational study. Study was conducted at neuro medicine ward at JPMC Karachi from March 2015 to March 2018. Total 110 patients were included. All diagnosed patients of TBM above 12 years of age were included. Mortality and Morbidity of the patients were recorded. The predictors of mortality were also assessed. Patient with other CNS disease were excluded from study. RESULTS: Male patients were predominantly (60%) involved. Mortality was 10%. Complication in TBM in descending order were Hydrocephalus 60%, Cranial nerve palsies 40%, Hyponatremia 40%, Stroke 30%, Papilledema 20%, Myelitis 10%, Ataxia 10%, Acute seizure 10% and Dementia 10%. Hydrocephalus, use of mechanical ventilation, TLC more than 9000 were present 100% in all 11 dead patients. At the end of standard duration of treatment 70% of patients had complete recovery without residual deficit. 20% patient had residual deficit and (10%) died. CONCLUSION: Mortality of TBM patient is very high in stage III presentation, Hydrocephalus, Hyponatremic and use of ventilation are predictor of mortality. Hydrocephalus, Cranial nerve palsies, Hyponatremia and Stroke are common complication and less common complications are Myelitis, Papilledema, Acute seizure and Dementia.