Reasons for re-hospitalization in patients with tuberculous meningitis, and its impact on outcome : a prospective observational study
© 2022. The Author(s) under exclusive licence to Belgian Neurological Society..
BACKGROUND: Patients with tuberculous meningitis may worsen despite being treated adequately with anti-tuberculosis drugs. This worsening may lead to re-hospitalization. The exact frequency and causes of re-hospitalization have not been studied previously. We aimed to study the causes of clinical worsening leading to re-hospitalization and its impact on prognosis.
METHODS: This was a prospective observational study. Newly diagnosed patients with tuberculous meningitis (N = 150) were enrolled. Baseline clinical evaluation, neuroimaging, and cerebrospinal fluid examination were performed. Anti-tuberculosis drug regimen and corticosteroids were given as per WHO guidelines. Patients were followed for 6 months. Re-hospitalized patients were worked up and clinical evaluation, neuroimaging, and cerebrospinal fluid examination were performed again. Outcome assessment was done at the end of 6 months, and a modified Barthel index of ≤ 12 was considered a poor outcome.
RESULTS: Twenty-three (15.3%) out of 150 patients needed re-hospitalization. The median time between discharge after the first hospitalization and re-hospitalization was 60 days. The common reasons for re-hospitalization were paradoxical neurological deterioration seen in 19 (82.6%) out of 23 patients, followed by drug toxicities (N = 2) and systemic involvement (N = 2). Paradoxically developed spinal arachnoiditis and opto-chiasmatic arachnoiditis were amongst the predominant reasons for re-hospitalization. At six months, re-hospitalization was an independent predictor of poor outcome (OR = 7.39, 95% CI 2.26-24.19).
CONCLUSION: Approximately 15% of tuberculous meningitis patients needed re-hospitalization. Paradoxically developed spinal arachnoiditis and opto-chiasmatic arachnoiditis were predominant reasons for re-hospitalization. Re-hospitalization adversely affected the outcome.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:123 |
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| Enthalten in: |
Acta neurologica Belgica - 123(2023), 5 vom: 28. Okt., Seite 1869-1883 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Patil, Manish Ramesh [VerfasserIn] |
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| Links: |
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| Themen: |
Antitubercular Agents |
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| Anmerkungen: |
Date Completed 18.09.2023 Date Revised 22.09.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1007/s13760-022-02123-8 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 100 | 1 | |a Patil, Manish Ramesh |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Reasons for re-hospitalization in patients with tuberculous meningitis, and its impact on outcome |b a prospective observational study |
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| 520 | |a © 2022. The Author(s) under exclusive licence to Belgian Neurological Society. | ||
| 520 | |a BACKGROUND: Patients with tuberculous meningitis may worsen despite being treated adequately with anti-tuberculosis drugs. This worsening may lead to re-hospitalization. The exact frequency and causes of re-hospitalization have not been studied previously. We aimed to study the causes of clinical worsening leading to re-hospitalization and its impact on prognosis | ||
| 520 | |a METHODS: This was a prospective observational study. Newly diagnosed patients with tuberculous meningitis (N = 150) were enrolled. Baseline clinical evaluation, neuroimaging, and cerebrospinal fluid examination were performed. Anti-tuberculosis drug regimen and corticosteroids were given as per WHO guidelines. Patients were followed for 6 months. Re-hospitalized patients were worked up and clinical evaluation, neuroimaging, and cerebrospinal fluid examination were performed again. Outcome assessment was done at the end of 6 months, and a modified Barthel index of ≤ 12 was considered a poor outcome | ||
| 520 | |a RESULTS: Twenty-three (15.3%) out of 150 patients needed re-hospitalization. The median time between discharge after the first hospitalization and re-hospitalization was 60 days. The common reasons for re-hospitalization were paradoxical neurological deterioration seen in 19 (82.6%) out of 23 patients, followed by drug toxicities (N = 2) and systemic involvement (N = 2). Paradoxically developed spinal arachnoiditis and opto-chiasmatic arachnoiditis were amongst the predominant reasons for re-hospitalization. At six months, re-hospitalization was an independent predictor of poor outcome (OR = 7.39, 95% CI 2.26-24.19) | ||
| 520 | |a CONCLUSION: Approximately 15% of tuberculous meningitis patients needed re-hospitalization. Paradoxically developed spinal arachnoiditis and opto-chiasmatic arachnoiditis were predominant reasons for re-hospitalization. Re-hospitalization adversely affected the outcome | ||
| 650 | 4 | |a Observational Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Paradoxical reaction | |
| 650 | 4 | |a Prognosis | |
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| 650 | 4 | |a Tuberculous meningitis | |
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| 700 | 1 | |a Rizvi, Imran |e verfasserin |4 aut | |
| 700 | 1 | |a Garg, Ravindra Kumar |e verfasserin |4 aut | |
| 700 | 1 | |a Malhotra, Hardeep Singh |e verfasserin |4 aut | |
| 700 | 1 | |a Kumar, Neeraj |e verfasserin |4 aut | |
| 700 | 1 | |a Uniyal, Ravi |e verfasserin |4 aut | |
| 700 | 1 | |a Pandey, Shweta |e verfasserin |4 aut | |
| 700 | 1 | |a Verma, Rajesh |e verfasserin |4 aut | |
| 700 | 1 | |a Sharma, Praveen Kumar |e verfasserin |4 aut | |
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