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 which could be associated with a poorer outcome. Out of 40 consecutive TBM patients seen over a period of 4 years in a tertiary referral hospital, 18 culture 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 males and 13 females. None had any associated active chronic medical illness. Patients (44.4%) started on antituberculous treatment within 24 h of admission. Treatment was initiated at a median time of 48 h upon admission in hospital. Univariate analysis revealed a significant correlation between hydrocephalus (P=0.007) and poor morbidity and mortality. The other clinical factors were not statistically significant: age (P=0.36); sex (P=0.49); symptom 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 treatment (P=0.94) and stage of disease (P=0.11). Hydrocephalus was the only significant factor predisposing culture positive TBM patients to a poorer outcome. There was also a trend towards a poorer prognosis in those with advanced stage of the disease.