TUBERCULOUS-MENINGITIS IN ADULTS - REVIEW OF 48 CASES

The cases of 48 adult patients with tuberculous meningitis who were ad mitted to an intensive care unit (ICU) between 1982 and 1993 sere: rev iewed. An underlying disease was present in 24 patients (50%), includi ng 10 with human immunodeficiency virus infection. Forty-seven patient s were referred to the ICU because of neurological deterioration; 22 w ere comatose at admission. Forty-six patients received antituberculous treatment; 36 required mechanical ventilatory support, and 16 underwe nt neurosurgery. Thirty-one patients died within 4 months after admiss ion, and the remaining 17 were alive at a 1-year follow-up. Univariate prognostic analysis selected three variables, all assessed at admissi on, associated with outcome: time to onset of treatment of greater tha n or equal to 3 days (P = .003), coma (P = .006), and simplified acute physiology score of >11 (P = .03). Thus, the outcome of tuberculous m eningitis is mainly determined by the clinical stage at admission and the delay in starting treatment. These findings underscore the need to initiate early therapy as soon as the diagnosis of tuberculous mening itis is suspected.