Culture positive tuberculous meningitis: clinical indicators of poor prognosis

Few studies have evaluated culture positive tuberculous meningitis (TBM) as a group. We evaluated certain clinical factors in culture positive TBM whi ch could be associated with a poorer outcome. Out of 40 consecutive TBM pat ients seen over a period of 4 years in a tertiary referral hospital, 18 cul ture positive and non-human immunodeficiency virus (HIV) related cases were studied. The mean age was 37.9 +/- 14.9 years (range 9-63); five were male s and 13 females. None had any associated active chronic medical illness. P atients (44.4%) started on antituberculous treatment within 24 h of admissi on. Treatment was initiated at a median time of 48 h upon admission in hosp ital. Univariate analysis revealed a significant correlation between hydroc ephalus (P = 0.007) and poor morbidity and mortality. The other clinical fa ctors were not statistically significant: age (P = 0.36); sex (P = 0.49); s ymptom duration (P = 0.69); BCG vaccination (P = 0.65); cerebral infarct (P = 0.63); extrameningeal spread (P = 1.00); steroids (P = 1.00); time to tr eatment (P = 0.94) and stage of disease (P = 0.11). Hydrocephalus was the o nly significant factor predisposing culture positive TBM patients to a poor er outcome. There was also a trend towards a poorer prognosis in those with advanced stage of the disease. (C) 1999 Elsevier Science B.V. All rights r eserved.