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SETTING: Centre for Tropical Diseases, a 500-bed hospital for infectious diseases in Ho Chi Minh City, Vietnam. OBJECTIVE: The factors that determine outcome in adults with tuberculous meningitis are poorly understood. The objective of the study was to investigate the relationship between admission clinical features, HIV infection, drug resistance, mycobacterial genotype and outcome in adults with tuberculous meningitis. DESIGN: Clinical and laboratory data were recorded prospectively for 56 Vietnamese adults with tuberculous meningitis confirmed by culture of cerebrospinal fluid. Variables associated with in-hospital mortality, IV infection, drug resistance and microbial genotype were assessed by univariate and multivariate analysis. RESULTS: Admission coma score independently predicted death in hospital (OR 0.73, 95%CI 0.61-0.87, P = 0.001). HIV-infected adults with tuberculous meningitis were more likely to be infected with Mycobacterium tuberculosis resistant to isoniazid (P = 0.011) and streptomycin (P = 0.002). Isoniazid resistance, streptomycin resistance, HIV infection and microbial genotype were not associated with increased in-hospital mortality. CONCLUSION: Treatment of tuberculous meningitis before the onset of coma saves lives. Resistance to isoniazid and/or streptomycin does not appear to affect outcome.

Type

Journal article

Journal

The international journal of tuberculosis and lung disease

Publication Date

10/2002

Volume

6

Pages

865 - 871

Addresses

Nuffield Department of Clinical Medicine, John Radcliffe Hospital, University of Oxford, UK. gthwaites@hcm.vnn.vn

Keywords

Lung, Sputum, Humans, Mycobacterium tuberculosis, Tuberculosis, Meningeal, HIV Infections, Isoniazid, Antitubercular Agents, Prospective Studies, Drug Resistance, Bacterial, Genotype, Adolescent, Adult, Middle Aged, Outcome Assessment (Health Care), Vietnam, Female, Male