Article Text

  1. M. K. Leonard,
  2. A. Arndt,
  3. M. Barragán,
  4. M. T. Porkert,
  5. C. Del Rio,
  6. H. Blumberg
  1. Emory University School of Medicine, Atlanta, GA


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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