TUBERCULOUS MENINGITIS AMONG ADULTS WITH AND WITHOUT HIV-INFECTION - EXPERIENCE IN AN URBAN PUBLIC HOSPITAL

Background: Tuberculous meningitis remains a frequently diagnosed enti ty in urban US hospitals, with the incidence increasing as a consequen ce of infection with the human immunodeficiency virus (HIV). Objective : To describe the occurrence, characteristics, and therapeutic respons es of tuberculous meningitis among adult patients of an urban public h ospital, with special attention to the effects of HIV infection. Desig n: Retrospective clinical review of all cases identified among adults over a 12-year interval, collecting demographic and clinical variables . Setting: A 550-bed urban teaching hospital. Main Outcome Measure: Ni ne-month outcome stratified by survival. Results: Among 31 adult patie nts identified as having definite or probable tuberculous meningitis, a majority (n=20 [65%]) were infected with HIV. Cumulative rates of oc currence per 100 000 persons over the 12 years of the study were estim ated at 1.72 for those without HIV infection and 400 for those with HI V infection. The most common symptoms at presentation were fever (83% [24/29]) and abnormal mental status (71% [20/28]). One or more abnorma lities were present in the cerebrospinal fluid of 97% (30/31) of subje cts, and 74% (23/31) had cerebrospinal fluid cultures positive for Myc obacterium tuberculosis. Neuroimaging of 28 patients revealed 1 or mor e abnormalities in 82% (n=23). Among 30 patients with available outcom e data at 9 months, 43% (n=13) had died, 40% (n=12) had survived witho ut sequelae, and 17% (n=5) had survived with morbidity. HIV infection had no discernible effect on findings. Conclusions: Tuberculous mening itis remains relatively common among indigent urban nonwhite populatio ns. While HIV infection has contributed to the increased incidence of tuberculous meningitis, it has not significantly altered the presentin g clinical, laboratory, or radiographic findings or the response to th erapy of this disease. Parameters associated in a multivariate regress ion analysis with mortality at 9 months were black race and the absenc e of corticosteroid use.