Hydrocephalus and vasculitis delay therapeutic responses in tuberculous meninigitis: Results of Haydarpasa-III study
Date
2016Author
Cag, YaseminOzturk-Engin, Derya
Gencer, Serap
Hasbun, Rodrigo
Sengoz, Gonul
Crisan, Alexandru
Ceran, Nurgul
Savic, Branislava
Yasar, Kadriye
Pehlivanoglu, Filiz
Kilicoglu, Gamze
Tireli, Hulya
Inal, Ayse S.
Civljak, Rok
Tekin, Recep
Elaldi, Nazif
Ulu-Kilic, Aysegul
Ozguler, Muge
Namiduru, Mustafa
Sunbul, Mustafa
Sipahi, Oguz R.
Dulovic, Olga
Alabay, Selma
Akbulut, Ayhan
Sener, Alper
Lakatos, Botond
Andre, Katell
Yemisen, Mucahit
Oncu, Serkan
Nechifor, Mihai
Deveci, Ozcan
Senbayrak, Seniha
Inan, Asuman
Dragovac, Gorana
Gul, Hanefi C.
Mert, Gurkan
Oncul, Oral
Kandemir, Bahar
Erol, Serpil
Agalar, Canan
Erdem, Hakan
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Aims: There is no report on the factors affecting the resolution of symptoms related to meningitis during treatment of tuberculous meningitis (TBM). Thus, we examined the factors associated with early therapeutic responses. Materials and Methods: This multicenter study included 507 patients with microbiologically confirmed TBM. However, 94 patients eligible for the analysis were included in this study from 24 centers. Six out of 94 patients died and the statistical analysis was performed with 88 survivors. Early and late responder groups were compared in the statistical analysis. P < 0.05 were considered to show a significant difference. Results: In the multivariate analysis, the presence of vasculitis (P = 0.029, OR = 10.491 [95% CI, 1.27u86.83]) was found to be significantly associated with a delayed fever response whereas hydrocephalus was associated with altered mental status for 9 days duration (P = 0.005, OR = 5.740 [95% CI, 1.68u19.57]). According to linear regression analysis, fever was significantly persisting (7 days) in the presence of vasculitis (17.5 vs. 7, P< 0.001) and hydrocephalus (11 vs. 7, P = 0.029). Hydrocephalus was significantly associated with persisting headache (21 vs. 12, P = 0.025), delayed recovery of consciousness (19.5 vs. 7, P = 0.001), and a delay in complete recovery (21 vs. 14, P = 0.007) in the linear regression analysis. Following institution of treatment, the complaints seemed to disappear in up to 2 weeks among TBM survivors. Conclusions: In the absence of hydrocephalus or vasculitis, one week of anti-tuberculosis treatment seems to be adequate for the resolution of TBM symptoms. Hydrocephalus and vasculitis delay the resolution of TBM symptoms in response to antimycobacterial treatment.
Source
NEUROLOGY INDIAVolume
64Issue
5Collections
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