Reasons for re-hospitalization in patients with tuberculous meningitis, and its impact on outcome: a prospective observational study.

Abstract

BACKGROUND:

Patients with tuberculous meningitis may worsen despite being treated adequately with anti-tuberculosis drugs. This worsening may lead to re-hospitalization. The exact frequency and causes of re-hospitalization have not been studied previously. We aimed to study the causes of clinical worsening leading to re-hospitalization and its impact on prognosis.

METHODS:

This was a prospective observational study. Newly diagnosed patients with tuberculous meningitis (N = 150) were enrolled. Baseline clinical evaluation, neuroimaging, and cerebrospinal fluid examination were performed. Anti-tuberculosis drug regimen and corticosteroids were given as per WHO guidelines. Patients were followed for 6 months. Re-hospitalized patients were worked up and clinical evaluation, neuroimaging, and cerebrospinal fluid examination were performed again. Outcome assessment was done at the end of 6 months, and a modified Barthel index of ≤ 12 was considered a poor outcome.

RESULTS:

Twenty-three (15.3%) out of 150 patients needed re-hospitalization. The median time between discharge after the first hospitalization and re-hospitalization was 60 days. The common reasons for re-hospitalization were paradoxical neurological deterioration seen in 19 (82.6%) out of 23 patients, followed by drug toxicities (N = 2) and systemic involvement (N = 2). Paradoxically developed spinal arachnoiditis and opto-chiasmatic arachnoiditis were amongst the predominant reasons for re-hospitalization. At six months, re-hospitalization was an independent predictor of poor outcome (OR = 7.39, 95% CI 2.26-24.19).

CONCLUSION:

Approximately 15% of tuberculous meningitis patients needed re-hospitalization. Paradoxically developed spinal arachnoiditis and opto-chiasmatic arachnoiditis were predominant reasons for re-hospitalization. Re-hospitalization adversely affected the outcome.

• Authors: Manish Ramesh Patil, Imran Rizvi, Ravindra Kumar Garg, Hardeep Singh Malhotra, Neeraj Kumar, Ravi Uniyal, Shweta Pandey, Rajesh Verma, Praveen Kumar Sharma
• Journal: Acta neurologica Belgica (Acta Neurol Belg) Vol. 123 Issue 5 Pg. 1869-1883 (Oct 2023) ISSN: 2240-2993 [Electronic] Italy
• PMID: 36306031 (Publication Type: Observational Study, Journal Article)
• Copyright: © 2022. The Author(s) under exclusive licence to Belgian Neurological Society.

Chemical References

• Antitubercular Agents

Topics

• Humans
• Tuberculosis, Meningeal (complications, drug therapy)
• Arachnoiditis
• Prospective Studies
• Antitubercular Agents (therapeutic use)
• Hospitalization