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 ORIGINAL ARTICLE
Year : 2016  |  Volume : 64  |  Issue : 5  |  Page : 896--905

Hydrocephalus and vasculitis delay therapeutic responses in tuberculous meninigitis: Results of Haydarpasa-III study


1 Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey
2 Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
3 Department of Infectious Diseases and Clinical Microbiology, Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
4 Department of Infectious Diseases, Medical School, The University of Texas Health Science Center at Houston, USA
5 Department of Infectious Diseases and Clinical Microbiology, Haseki Training and Research Hospital, Istanbul, Turkey
6 Department of Infectious Diseases, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
7 Faculty of Medicine, National Reference Laboratory for Tuberculosis, Institute of Microbiology and Immunology, University of Belgrade, Belgrade, Serbia
8 Department of Infectious Diseases and Clinical Microbiology, Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
9 Department of Infectious Diseases and Clinical Microbiology, Cukurova University School of Medicine, Adana, Turkey
10 Department of Infectious Diseases, Dr. Fran Mihaljevic University Hospital for Infectious Diseases, University of Zagreb School of Medicine, Zagreb, Croatia
11 Department of Infectious Diseases and Clinical Microbiology, Dicle University School of Medicine, Diyarbakir, Turkey
12 Department of Infectious Diseases and Clinical Microbiology, Cumhuriyet University School of Medicine, Sivas, Turkey
13 Department of Infectious Diseases and Clinical Microbiology, Erciyes University School of Medicine, Kayseri, Turkey
14 Department of Infectious Diseases and Clinical Microbiology, Firat University School of Medicine, Elazig, Turkey
15 Department of Infectious Diseases and Clinical Microbiology, Gaziantep University School of Medicine, Gaziantep, Turkey
16 Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University School of Medicine, Samsun, Turkey
17 Department of Infectious Diseases and Clinical Microbiology, Ege University School of Medicine, Izmir, Turkey
18 Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University School of Medicine, Samsun, Turkey
19 Department of Infectious Diseases and Clinical Microbiology, Onsekiz Mart University School of Medicine, Canakkale, Turkey
20 Department of Infectious Diseases, Saint Laszlo Hospital, Budapest, Hungary
21 Department of Infectious Diseases, Dax Hospital, France
22 Department of Infectious Diseases and Clinical Microbiology, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
23 Department of Infectious Diseases and Clinical Microbiology, Adnan Menderes University School of Medicine, Aydin, Turkey
24 Department of Infectious Diseases, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania
25 Department of Prevention and Control of Diseases, Medical Faculty, IPH of Vojvodina, University of Novi Sad, Serbia
26 Department of Infectious Diseases and Clinical Microbiology, Gulhane Medical Academy, Ankara, Turkey
27 Istanbul Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul University, Istanbul, Turkey
28 Department of Infectious Diseases and Clinical Microbiology, Necmettin Erbakan University School of Medicine, Konya, Turkey
29 Department of Infectious Diseases and Clinical Microbiology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey

Correspondence Address:
Hakan Erdem
Department of Infectious Diseases and Clinical Microbiology, Gulhane Medical Academy, Ankara
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.190258

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Aims: There is no report on the factors affecting the resolution of symptoms related to meningitis during treatment of tuberculous meningitis (TBM). Thus, we examined the factors associated with early therapeutic responses. 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.






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