Outcomes of Tuberculous Meningitis Patients with or without Hydrocephalus from a Tertiary Hospital in West Java, Indonesia

Nubella Citresna Zakiyyah, Suryani Gunadharma, Ahmad Rizal Ganiem

Abstract


Background: Tuberculous meningitis (TBM) is a severe form of extrapulmonary tuberculosis. One of the most common complications of TBM is hydrocephalus, with a higher risk of mortality. This study aimed to evaluate the outcome among TBM patients with or without hydrocephalus.

Methods: This study was a retrospective cross-sectional comparative analytical study. A total sampling was employed based on the number of traceable resumes of TBM patients treated at the Department of Neurology Dr. Hasan Sadikin General Hospital, Bandung, Indonesia in 2018.

Results: Of the 127 data of TBM patients, 55 (43.3%) had hydrocephalus, and 72 (56.7%) did not. The median age of TBM patients with and without hydrocephalus was 34 years (IQR 26–45) and 35 years (IQR 24–44), respectively. Decreased consciousness dominated the clinical symptoms for 94.5% in the hydrocephalus group and 84.7% in the non-hydrocephalus group. Hospital-acquired pneumonia occurred mainly in the hydrocephalus group (29.1%), whereas urinary tract infections mainly occurred in without hydrocephalus group (18%). There was a significant difference between the outcome of hydrocephalus and non-hydrocephalus (p=0.005). Mortality was higher in patients with hydrocephalus compared to those without hydrocephalus.

Conclusions: The outcome of TBM patients with hydrocephalus is worse than those without hydrocephalus, as reflected by a higher grade of TBM, higher mortality rate, and lower good recovery upon treatment administration. Therefore, prompt diagnosis and treatment are needed to improve the outcome and survival among TBM patients with hydrocephalus.


Keywords


Hydrocephalus; outcome characteristic; TB meningitis  

Full Text:

PDF

References


  1. WHO. Global tuberculosis report 2019. Geneva: WHO; 2019.
  2. Brooks GF, Jawetz E, Melnick JL, Adelberg EA. Jawetz, Melnick & Adelberg medical microbiology. 25th Ed. New York: McGraw Hill Medical; 2010.
  3. Raut T, Garg RK, Jain A, Verma R, Singh MK, Malhotra HS, et al. Hydrocephalus in tuberculous meningitis: incidence, its predictive factors and impact on the prognosis. J Infect. 2013;66(4):330–7.
  4. Manyelo CM, Solomons RS, Walzl G, Chegou NN. Tuberculous meningitis: pathogenesis, immune responses, diagnostic challenges, and the potential of biomarker-based approaches. J Clin Microbiol. 2021; 59(3):e01771–20.
  5. Jeon CY, Murray MB. Diabetes mellitus increases the risk of active tuberculosis: a systematic review of 13 observational studies. PLoS Med. 2008;5(7):e152.
  6. Chin JH. Tuberculous meningitis: diagnostic and therapeutic challenges. Neurol Clin Pract. 2014;4(3):199–205.
  7. Soria J, Metcalf T, Mori N, Newby RE, Montano SM, Huaroto L, et al. Mortality in hospitalized patients with tuberculous meningitis. BMC Infect Dis. 2019;19(1):9.
  8. Davis AG, Rohlwink UK, Proust A, Figaji AA, Wilkinson RJ. The pathogenesis of tuberculous meningitis. J Leukoc Biol. 2019;105(2):267–80.
  9. Huynh J, Abo Y, Preez K, Solomons R, Dooley KE, Seddon JA. Tuberculous meningitis in children: reducing the burden of death and disability. Pathogens. 2021;11(1):38.
  10. Munir B, Prayudi F, Setianto CA, Siswanto S. Factors affecting prognosis of tuberculous meningitis in Saiful Anwar General Hospital Malang. Malang Neurol J. 2020;6(1):1–4.
  11. Wang MS, Zhao M, Liu XJ. Risk factors for poor outcome in childhood tuberculous meningitis. Sci Rep. 2021;11(1):8654.
  12. Kanesen D, Kandasamy R, Hieng AWS, Tharakan J, Joo LC, Abdullah JM. Clinical outcome of tuberculous meningitis with hydrocephalus-a retrospective study. Malays J Med Sci. 2021;28(5):82–93.
  13. Yiek SH, Wong AS. Challenges and controversies in the management of tuberculous meningitis with hydrocephalus: a systematic review and sarawak institution’s experience. Asian J Neurosurg. 2022;17(2):189–98.
  14. Chalasani R, Goonathilake MR, Waqar S, George S, Jean-Baptiste W, Yusuf Ali A, et al. The outcome of surgical intervention (ventriculoperitoneal shunt and endoscopic third ventriculostomy) in patients with hydrocephalus secondary to tuberculous meningitis: a systematic review. Cureus. 2022;14(5):e25317.
  15. Luo M, Wang W, Zeng Q, Luo Y, Yang H, Yang X. Tuberculous meningitis diagnosis and treatment in adults: a series of 189 suspected cases. Exp Ther Med. 2018;16(3):2770–6.
  16. Wen L, Li M, Xu T, Yu X, Wang L, Li K. Clinical features, outcomes and prognostic factors of tuberculous meningitis in adults worldwide: systematic review and meta‑analysis. J Neurol. 2019;266(12):3009–21.
  17. Cooksley T, Rose S, Holland M. A systematic approach to the unconscious patient. Clin Med (Lond). 2018;18(1):88–92.
  18. Edlow JA, Rabinstein A, Traub SJ, Wijdicks EF. Diagnosis of reversible causes of coma. Lancet. 2014;384(9959):2064–76
  19. Kumar S, Verma R, Garg RK, Malhotra HS, Sharma PK. Prevalence and outcome of headache in tuberculous meningitis. Neurosciences (Riyadh). 2016;21(2):138–44.
  20. Wilson MH. Monro-Kellie 2.0: the dynamic vascular and venous pathophysiological components of intracranial pressure. J Cereb Blood Flow Metab. 2016;36(8):1338–50.
  21. Barnett DL 2nd, Rosenbaum RA, Diaz JR. Refractory nausea and vomiting in the setting of well-controlled idiopathic intracranial hypertension. BMJ Case Rep. 2014;2014:bcr2014203724.
  22. Dux M, Rosta J, Messlinger K. TRP Channels in the focus of trigeminal nociceptor sensitization contributing to primary headaches. Int J Mol Sci. 2020;21(1):342.
  23. Abdulaziz ATA, Li J, Zhou D. The prevalence, characteristics and outcome of seizure in tuberculous meningitis. Acta Epileptologica. 2020;2(1):1–9.
  24. Budiman ATM, Suraya N, Faried A, Parwati I. Characteristics of cerebrospinal fluid in tuberculous meningitis patients with hydrocephalus. IJIHS. 2018;6(2):57–62.
  25. Oliveira LM, Nitrini R, Román GC. Normal-pressure hydrocephalus: a critical review. Dement Neuropsychol. 2019;13(2):133–43.
  26. Török ME. Tuberculous meningitis: advances in diagnosis and treatment. Br Med Bull. 2015;113(1):117–31.
  27. Hsu PC, Yang CC, Ye JJ, Huang PY, Chiang PC, Lee MH. Prognostic factors of tuberculous meningitis in adults: a 6-year retrospective study at a tertiary hospital in Northern Taiwan. J Microbiol Immunol Infect. 2010;43(2):111–8.
  28. Tandon V, Mahapatra AK. Management of post-tubercular hydrocephalus. Child Nerv Syst. 2011;27(10):1699–707.
  29. Eftekhari S, Westgate CSJ, Uldall MS, Jensen RH. Preclinical update on regulation of intracranial pressure in relation to idiopathic intracranial hypertension. Fluids Barriers CNS. 2019 Nov 26;16(1):35.
  30. Huang HJ, Ren ZZ, Dai YN, Tong YX, Yang DH, Chen MJ, et al. Old age and hydrocephalus are associated with poor prognosis in patients with tuberculous meningitis: a retrospective study in a Chinese adult population. Medicine (Baltimore). 2017;96(26):e7370.




DOI: https://doi.org/10.15850/amj.v9n4.2304

Article Metrics

Abstract view : 458 times
PDF - 451 times


 This Journal indexed by

                  

          

 

Creative Commons License
AMJ is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License

 


View My Stats