Outcomes of patients presenting with central nervous system tuberculosis at a tertiary care center in India

Authors

  • Santhosh Rajendran Department of Medicine, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat
  • Darshil Shah Department of Neurology, Hackensack University Medical Center, Hackensack, NJ
  • Fatema Kapadia Department of Psychiatry, Maimonides Medical Center, New York
  • Ruchi Jani Smt. NHL Municipal Medical College, Ahmedabad, Gujarat
  • Jinal Pandya Department of Physiology, M.K. Shah Medical College, Ahmedabad, Gujarat
  • Harpreet Singh Department of Medicine, Mount Auburn Hospital, Beth-Israel Lahey Health, Cambridge, MA
  • Chinmay Jani Department of Medicine, Mount Auburn Hospital, Beth-Israel Lahey Health, Cambridge, MA Harvard Medical School, Boston, MA,
  • Ami Parikh Department of Medicine, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20205407

Keywords:

CNS tuberculosis, Tubercular meningitis, Tuberculoma, Tuberculosis

Abstract

Background: Tuberculosis (TB) is a major public health problem in India. Ten percent of all patients with TB have CNS involvement.  Delayed diagnosis of this disease is associated with increased mortality. This study assesses the socio-demographic profile as well as outcomes in patients with various forms of CNS TB.  

Methods: A prospective observational study conducted at V.S. Hospital, Ahmedabad, between December-2016 and February-2018. Each patient was assessed from admission to 3- month follow up. The diagnosis of tuberculous meningitis (TBM) and tuberculoma was done as per the Ahuja and Rajashekhar criteria, respectively. Neurological status and functional outcome were graded based on modified Rankin score (mRS).  

Results: Our study had 56 patients with a mean age of 35.01±11.46 years.  We observed that increasing age was associated with higher mRS (p=0.002). Fever was the most common symptom in patients with TBM (96. 15%), unlike seizures (100%) in patients with tuberculomas with or without TBM. Patients with either isolated TBM or tuberculoma had improvement in outcomes. On multivariate analysis, it was found that CN palsy (HR=0.38, p=0.003), duration of illness (HR=0.35, p=0.005) and age (HR=0.33, p=0.008) were the most significant predictor of worse outcomes.  

Conclusions: Identification and evaluation of focal signs like seizures and focal neurological deficits along with certain non-focal signs like headache and fever should raise high level of suspicion for TB in tropical regions at the primary care levels for early diagnosis and treatment.

Author Biographies

Santhosh Rajendran, Department of Medicine, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat

Department of Medicine, Smt NHL Municipal Medical College, Ahmedabad, Gujarat, India.

Darshil Shah, Department of Neurology, Hackensack University Medical Center, Hackensack, NJ

Clinical Research Coordinator,
Neuroscience Institute,
Department of Neurology,
Hackensack University Medical Center.

Fatema Kapadia, Department of Psychiatry, Maimonides Medical Center, New York

Department of Psychiatry, Maimonides Medical Center, New York, USA.

Ruchi Jani, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat

Medical Student, Smt NHL Municipal Medical College, Ahmedabad, Gujarat, India.

Jinal Pandya, Department of Physiology, M.K. Shah Medical College, Ahmedabad, Gujarat

Department of Physiology, M.K. Shah Medical College, Ahmedabad, Gujarat, India.

Harpreet Singh, Department of Medicine, Mount Auburn Hospital, Beth-Israel Lahey Health, Cambridge, MA

Department of Medicine, Mount Auburn Hospital, Beth-Israel Lahey Health, Cambridge, MA, USA.

Harvard Medical School, Boston, MA, USA.

Chinmay Jani, Department of Medicine, Mount Auburn Hospital, Beth-Israel Lahey Health, Cambridge, MA Harvard Medical School, Boston, MA,

Department of Medicine, Mount Auburn Hospital, Beth-Israel Lahey Health, Cambridge, MA, USA.

Harvard Medical School, Boston, MA, USA.

Ami Parikh, Department of Medicine, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat

Department of Medicine, Smt NHL Municipal Medical College, Ahmedabad, Gujarat, India.

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Published

2020-12-25

How to Cite

Rajendran, S., Shah, D., Kapadia, F., Jani, R., Pandya, J., Singh, H., Jani, C., & Parikh, A. (2020). Outcomes of patients presenting with central nervous system tuberculosis at a tertiary care center in India. International Journal Of Community Medicine And Public Health, 8(1), 138–146. https://doi.org/10.18203/2394-6040.ijcmph20205407

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Original Research Articles