Hydrocephalus and vasculitis delay therapeutic responses in tuberculous meninigitis: Results of Haydarpasa-III study.
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Cag Yasemin, Ozturk-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, G L Hanefi C, Mert Gurkan, Oncul Oral, Kandemir Bahar, Erol Serpil, Agalar Canan, Erdem Hakan
Аннотация
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, 1.27-86.83]) 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, 1.68-19.57]). 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.