DOI: 10.36347/sjams.2019.v07i12.050

Pages: 4080-4084

Aim and objective: To study clinical profile of adults with Tuberculous meningitis (TBM) admitted to Department of Medicine IGMC Shimla (H.P.). Materials and Methods: It was an observational hospital-based study, total of 40 adult cases were admitted and treated as TBM over a period of 1 year (August 2015 and July 2016), in Department of Medicine, IGMC Shimla. The data on demographic factors, clinical treatment, complications and laboratory findings, details of treatment and outcome were recorded and analyzed. Results: A total of 40 cases were admitted and treated as TBM over a period of 1 year. Majority of the patients, 21(52.5%) belonged to age group 18-39 years with male preponderance (M:F=2.6:1); 75% patients had duration of illness upto 14 days. Common symptoms were fever in 33 (82.5%), headache 26(65%) and altered sensorium 27(67.5%). AFB culture was positive in 10% cases. CSF staining for AFB was negative for all patients. The positive polymerase chain reaction of TB PCR in 42.5% and mean ADA value was 9.09±7. On neuroimaging, 20% cases had meningeal enhancement, 12.9% had hydrocephalus and 13.3% had ischemic lesions and tuberculomas in 13.8%. 32.5% patients were in stage I, 57.5% in stage II and 10% in stage III. At discharge 57.5% patients were asymptomatic, 37.5% were having some residual Deficit and 2(5.0%) died before discharge. Conclusion: A major problem in diagnosis of TBM was the absence of standardized diagnostic criteria, but now with advent of consensus case definition there is a better diagnostic clarity. With the advent and availability of PCR diagnostic modalities the diagnostic pickup of TBM has improved. The role of PCR in TBM diagnosis is still evolving and presents window of opportunity for early diagnosis, detecting resistance pattern and treatment.