Abstract for presentation at The Australian and New Zealand Association of Neurologists Annual Scientific Meeting 2007

Purposes: To identify trends in the incidence and outcome of TB meningitis during the last 40 years; the frequency and reasons for delays in starting anti-TB treatment; and the frequency of complications.
Methods: Retrospective review using multiple case finding methods. Definite TB meningitis was defined as (1) one or more of headache, neck stiffness, altered mental state and fever, (2) CSF pleocytosis and (3) culture of M.tuberculosis from the CSF or another site, or a positive PCR assay for M. tuberculosis. Probable TB meningitis was defined as 1 and 2 above, plus a response to anti-TB treatment and exclusion of other causes of meningitis.
Results: 104 patients with TB meningitis (71 definite, 33 probable) presented between 1965 and 2004. On average, 2-3 new cases presented each year. 33% were Pacific people, 28% Maori, 28% European and 9% Asian. The frequency of complications was hyponatraemia 48%, hydrocephalus 37%, epileptic seizures 28%, cerebral infarcts 25%, coma 14%, tuberculoma 5%, diabetes insipidus 4%, intracranial haemorrhage 2%, paraplegia 2% and syringomyelia 1%. Delays in performing a lumbar puncture in 11 patients and incorrectly attributing CSF abnormalities to bacterial meningitis in 12 patients led to a delay in starting anti-TB treatment in 24% of the patients. The Glasgow Outcome Score (GOS) at discharge was 1 (death) 19%, 2 (persistent vegetative state) 2%, 3 (severe disability) 19%, 4 (moderate disability) 22% and 5 (good recovery) 37%.
Conclusions: Pacific people, Maori and Asians have a higher risk of developing TB meningitis. The advent of HIV infection has not affected the incidence of TB meningitis in Auckland. Delays in starting anti-TB treatment occurred in 25% of the patients. Serious neurological and systemic complications were common and 40% of patients had a poor outcome (GOS 1-3).