Background Tuberculosis (TB) in the US is primarily an inner-city disease and TB meningitis has historically been a dreaded complication of TB with a high mortality rate.
Methods We examined the epidemiology of TB meningitis at Grady Memorial Hospital (GMH), a 1,000-bed inner-city academic hospital in Atlanta, GA, by performing a retrospective chart review. Cases of TB meningitis were identified in the TB database maintained by the GMH Hospital Epidemiology Department.
Results During a 20.5-year period 97 patients were diagnosed with TB meningitis either by microbiological or clinical diagnosis. The median age was 36 years old, 72 (74%) were male, and 74 (76%) were of black race. Fifty-four (56%) were HIV positive and 24 (25%) were HIV status unknown. No significant differences were seen in the clinical presentation and laboratory results among HIV-positive and HIV-negative patients except HIV-positive patients had a lower median CSF white blood cell count of 68/mm3 versus 145/mm3 in HIV-negative patients. Mortality was striking in our study that overall, 32 (33%) patients died. HIV-positive patients (n = 25) were statistically more likely to die than HIV-negative patients (p = .005). The mean CD4 count for these was 141/mm3 and the mean CSF WBC was 1,898/mm3. Of the 97 patients who died, 79 (82%) were on four-drug TB therapy and 53 (59%) of 80 received steroids.
Conclusions Despite the availability of appropriate chemotherapy for TB meningitis, this disease remains a devastating disease with a high mortality rate among this cohort of inner-city patients. HIV-positive patients are at an even increased risk of dying from this form of TB.
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