HIV–A prognostic factor of tuberculous meningitis: A retrospective cohort study among adults in peninsular Malaysia
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Sultan Azlan Shah Training Institute of Ministry of Health Malaysia, Ministry of Health Malaysia, Perak, MALAYSIA
Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu, Terengganu, MALAYSIA
Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Kuala Terengganu, Terengganu, MALAYSIA
Department of Neurosciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, MALAYSIA
Department of Neurology, Hospital Kuala Lumpur, Ministry of Health Malaysia, Wilayah Persekutuan, Kuala Lumpur, MALAYSIA
Department of Respiratory, Hospital Pulau Pinang, Ministry of Health Malaysia, Pulau Pinang, MALAYSIA
Department of Respiratory, Hospital Sultanah Aminah, Ministry of Health Malaysia, Johor Bahru, Johor, MALAYSIA
Pharmacology Unit, Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500 Selangor Darul Ehsan, MALAYSIA
Center for Transdisciplinary Research, Department of Pharmacology, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, 600077, INDIA
Faculty of Health and Life Sciences, INTI International University, Nilai, MALAYSIA
Faculty of Dentistry, AIMST University, Bedong, Kedah, MALAYSIA
Centre for Global Health Research, Saveetha Medical College and Hospital, Chennai, Tamil Nadu, INDIA
Publication date: 2024-03-25
Electron J Gen Med 2024;21(2):em579
Tuberculous meningitis is a major public health issue, despite showing low incidence, tuberculous meningitis causes substantial mortality. For better clinical management, identification of prognostic factors is crucial to reduce health risk of Malaysian society. Therefore, the aim of this study was to determine the prognostic factors of adult tuberculous meningitis in peninsular Malaysia.

Materials & methods:
Initially, a retrospective cohort study and one-year of follow-up period was carried out. In addition, a total of 217 adult tuberculous meningitis patients treated or had follow-up in four tertiary hospitals in peninsular Malaysia were recruited. Cox proportional hazards regression was employed to perform multivariable analysis.

The overall survival probability of adult tuberculous meningitis was 36.8% with median survival time 244 days. Significant prognostic factors were Glasgow coma scale score (aHR=0.71, 95% CI=0.65, 0.76; p<0.001), HIV status (aHR=1.94, 95% confidence interval [CI]=1.19, 3.15; p=0.008), headache (aHR=0.48, 95% CI=0.31, 0.76; p=0.002) and meningeal enhancement (aHR=0.47, 95% CI=0.30, 0.74; p=0.001), nausea (aHR=2.21, 95% CI=1.33, 3.66; p=0.002), and vomit (aHR=0.58, 95% CI=0.36, 0.93; p=0.023).

Evidently, the survival of among adults with tuberculous meningitis was low. Since HIV positive has a significant influence in mortality; early screening, diagnosis, and prompt treatment in this subgroup of patients play a key role in survival.

Glaziou P, Floyd K, Raviglione MC. Global epidemiology of tuberculosis. Semin Respir Crit Care Med. 2018;39(3):271-85. https://doi.org/10.1055/s-0038... PMid:30071543.
Diah IM, Aziz N, Ahmad N. Relative risk estimation of tuberculosis with standardized morbidity ratio in Malaysia. Glob J Pure Appl Math. 2016;12(5):4011-9.
Adejumo OA, Daniel OJ, Otesanya AF, et al. Factors associated with TB/HIV co-infection among drug sensitive tuberculosis patients managed in a secondary health facility in Lagos, Nigeria. Afr J Infect Dis. 2017;11(2):75-82. https://doi.org/10.21010/ajid.... PMid:28670643 PMCid:PMC5476816.
Jullien S, Ryan H, Modi M, Bhatia R. Six months therapy for tuberculous meningitis. Cochrane Database Syst Rev. 2016;9(9):CD012091. https://doi.org/10.1002/146518... PMid:27581996 PMCid:PMC5018659.
Schaller MA, Wicke F, Foerch C, Weidauer S. Central nervous system tuberculosis: Etiology, clinical manifestations and neuroradiological feature. Clin Neuroradiol. 2019;29(1):3-18. https://doi.org/10.1007/s00062... PMid:30225516.
Ozturk-Engin D, Popescu CP. Tuberculous meningitis. In: Sener A, Erdem H, editors. Extrapulmonary tuberculosis. Springer; 2019. p. 101-120. https://doi.org/10.1007/978-3-....
Sy MCC, Espiritu AI, Pascual 5th JLR. Global frequency and cinical features of stroke in patients with tuberculous meningitis: A systematic review. JAMA Netw Open. 2022; 5(9):e2229282. https://doi.org/10.1001/jamane... PMid:36048445 PMCid:PMC9437750.
Rewari BB, Kumar A, Mandal PP, Puri AK. HIV TB coinfection-perspectives from India. Expert Rev Respir Med. 2021;15(7):911-30. https://doi.org/10.1080/174763... PMid:33900861.
Donovan J, Figaji A, Imran D, Phu NH, Rohlwink U, Thwaites GE. The neurocritical care of tuberculous meningitis. Lancet Neurol. 2019;18(8):771-83. https://doi.org/10.1016/S1474-... PMid:31109897.
Urlacher BR. Complexity, causality, and control in statistical modeling. Am Behav Sci. 2020;64(1):55-73. https://doi.org/10.1177/000276....
Young C, Walzl G, Du Plessis N. Therapeutic host-directed strategies to improve outcome in tuberculosis. Mucosal Immunol. 2020;13(2):190-204. https://doi.org/10.1038/s41385... PMid:31772320 PMCid:PMC7039813.
Cresswell FV, Te Brake L, Atherton R, et al. Intensified antibiotic treatment of tuberculosis meningitis. Expert Rev Clin Pharmacol. 2019;12(3):267-88. https://doi.org/10.1080/175124... PMid:30474434.
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. https://doi.org/10.1007/s00415... PMid:31485723.
Stadelman AM, Ellis J, Samuels THA, et al. Treatment outcomes in adult tuberculous meningitis: A systematic review and meta-analysis. Open Forum Infect Dis. 2020;7(8):ofaa257. https://doi.org/10.1093/ofid/o... PMid:32818138 PMCid:PMC7423296.
Abdulaziz ATA, Li J, Zhou D. The prevalence, characteristics and outcome of seizure in tuberculous meningitis. Acta Epileptol. 2020;2(1):1-8. https://doi.org/10.1186/s42494....
Selvaraj JU, Sujalini BB, Rohitson MS, George AA, Arvind VH, Mishra AK. Identification of predictors of cerebrovascular infarcts in patients with tuberculous meningitis. Int J Mycobacteriol. 2020;9(3):303-8. https://doi.org/10.4103/ijmy.i... PMid:32862165.
Horton KC, Hoey AL, Béraud G, Corbett EL, White RG. Systematic review and meta-analysis of sex differences in social contact patterns and implications for tuberculosis transmission and control. Emerg Infect Dis. 2020;26(5):910-9. https://doi.org/10.3201/eid260... PMid:32310063 PMCid:PMC7181919.
Chidambaram V, Tun NL, Majella MG, et al. Male sex is associated with worse microbiological and clinical outcomes following tuberculosis treatment: A retrospective cohort study, a systematic review of the literature, and meta-analysis. Clin Infect Dis. 2021;73(9):1580-8. https://doi.org/10.1093/cid/ci... PMid:34100919 PMCid:PMC8563313.
Al-Ghafli H, Varghese B, Enani M, et al. Demographic risk factors for extra-pulmonary tuberculosis among adolescents and adults in Saudi Arabia. PloS One. 2019;14(3):e0213846. https://doi.org/10.1371/journa... PMid:30917151 PMCid:PMC6436801.
Hsu P-C, Yang C-C, Ye J-Jr, Huang P-Y, Chiang P-C, Lee M-H. 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. https://doi.org/10.1016/S1684-... PMid:20457427.
Wilkinson RJ, Rohlwink U, Misra UK, et al. Tuberculous meningitis. Nat Rev Neurol. 2017;13(10):581-98. https://doi.org/10.1038/nrneur... PMid:28884751.
Thakur KT, Boubour A, Saylor D, Das M, Bearden DR, Birbeck GL. Global HIV neurology: A comprehensive review. AIDS. 2019;33(2):163-84. https://doi.org/10.1097/QAD.00... PMid:29547440 PMCid:PMC6139090.
Viktorova IB, Zimina VN, Degtyareva SY, Kravtchenko AV. Respiratory diseases in HIV-infected patients. J Infectol. 2020;12(4):5-18. https://doi.org/10.22625/2072-....
Hamada Y, Getahun H, Tadesse BT, Ford N. HIV-associated tuberculosis. Int J STD AIDS. 2021;32(9):780-90. https://doi.org/10.1177/095646... PMid:33612015 PMCid:PMC8236666.
Sereti I, Sheikh V, Shaffer D, et al. Prospective international study of incidence and predictors of immune reconstitution inflammatory syndrome and death in people living with human immunodeficiency virus and severe lymphopenia. Clin Infect Dis. 2020;71(3):652-60. https://doi.org/10.1093/cid/ci... PMid:31504347 PMCid:PMC7384325.
Kirdlarp S, Srichatrapimuk S, Kiertiburanakul S, Phuphuakrat A. Clinical features of adult patients with a definite diagnosis of central nervous system tuberculosis in an endemic country: A 13-year retrospective review. J Clin Tuberc Other Mycobact Dis. 2020;21:100190. https://doi.org/10.1016/j.jctu... PMid:32995572 PMCid:PMC7501451.
Seddon JA, Tugume L, Solomons R, Prasad K, Bahr NC, Tuberculous Meningitis International Research Consortium. The current global situation for tuberculous meningitis: Epidemiology, diagnostics, treatment and outcomes. Wellcome Open Res. 2019;4:167. https://doi.org/10.12688/wellc... PMid:32118118 PMCid:PMC7029758.
Logan C, Mullender C, Mirfenderesky M, et al. Presentations and outcomes of central nervous system TB in a UK cohort: the high burden of neurological morbidity. J Infect. 2021;82(1):90-7. https://doi.org/10.1016/j.jinf... PMid:33137354.
Raberahona M, Rakotoarivelo RA, Razafinambinintsoa T, Andrianasolo RL, de Dieu Randria MJ Clinical features and outcome in adult cases of tuberculous meningitis in tertiary care hospital in Antananarivo, Madagascar. Biomed Res Int. 2017;2017:9316589. https://doi.org/10.1155/2017/9... PMid:28396873 PMCid:PMC5371227.
Misra UK, Kalita J, Kumar M. Safety and efficacy of fludrocortisone in the treatment of cerebral salt wasting in patients with tuberculous meningitis: A randomized clinical trial. JAMA Neurol. 2018;75(11):1383-91. https://doi.org/10.1001/jamane... PMid:30105362 PMCid:PMC6248117.
Li QJ, Song J, Li XY, et al. Differentiation of intraspinal tuberculosis and metastatic cancer using magnetic resonance imaging. Infect Drug Resist. 2020;13:341-9. https://doi.org/10.2147/IDR.S2... PMid:32099425 PMCid:PMC7007797.
Maheswari EU, Bhoopathy RM, Bhanu K, Anandan H. Clinical spectrum of central nervous system tuberculosis and the efficacy of revised national tuberculosis control program in its management. J Neurosci Rural Pract. 2019; 10(01):71-7. https://doi.org/10.4103/jnrp.j... PMid:30765974 PMCid:PMC6337963.
Loddenkemper R, Lipman M, Zumla A. Clinical aspects of adult tuberculosis. Cold Spring Harb Perspect Med. 2016;6(1):a017848. https://doi.org/10.1101/cshper... PMid:25659379 PMCid:PMC4691808.
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