TABLE 5.7 Proportion of Patients Diagnosed with TB Meningitis Who Have Long-Term Neurologic Deficits

Study

No. Patients

All Adults?

No. Survivors

Time of Followup

No. (%) Survivors with Neurologic Deficits

Prospective Analyses

 

 

 

 

 

Lau et al. 2005

156a

nob

130

3 years

20 (15)

Kalita and Misra 1999

56

no

44

1 year

4 (9)

Retrospective Analyses

 

 

 

 

 

Sutlas et al. 2003

 

 

 

24 months-6 years

 

 

61

yes

44

(mean, 3 years)

19 (31)

Hosoglu et al. 1998

96a

yes

52

9 monthsc

21 (40)

Yechoor et al. 1996

30

yes

17

9 months

5 (29)

Verdon et al. 1996

48

yes

17

1 year

4 (24)

Bergin et al. 1989

28a

no

24

unspecified

7 (29)

a Patients not followed for the entire period are excluded from this table.

b Only seven patients were >15 years old during the acute phase of illness.

c A minimum followup period of 9 months is not directly stated in the article, but is inferred from the minimum duration of treatment reported. The committee was unable to obtain confirmation from the authors of the study.

In a recent study of the influence of HIV infection on the outcome of TB meningitis, the authors reported severe neurologic deficits in 5.9% (2/34) of HIV-positive survivors and 17% (53/310) of HIV-negative survivors (Thwaites et al. 2005). HIV status did not alter the neurologic presentation of TB meningitis but significantly reduced the survival rate.

Spinal Tuberculosis and Long-Term Neurologic Disability

It is well accepted in the biomedical community that spinal TB is associated with spinal deformity and neurologic outcomes. A review of 694 patients in Turkey, most of whom were treated both surgically and medically, reported that only 41% had improved after treatment (Turgut 2001). A series of 70 patients in India, of whom only one underwent surgery, reported that 74% had excellent to good results (Nene and Bhojraj 2005).

The committee concludes that there is sufficient evidence of an association between severe forms of pulmonary and extrapulmonary tuberculosis and long-term adverse health outcomes due to irreversible tissue damage.

Relapse of Active Tuberculosis

Even with current therapy under direct observation by health-care providers, relapse can occur in about 5% of treated patients and create a potential for additional late adverse health outcomes (CDC 2003a).

Potential Relationships Between Tuberculosis and Military Service

TB is potentially connected to military service in two ways. First, people who are TST-positive before deployment have LTBI and are at risk for developing active TB during deployment; troops with active TB in the field place other troops at risk for infection and disease. Second, troops who are TST-negative before deployment may become infected with TB during deployment. Such people occasionally manifest active TB shortly after infection but more frequently have LTBI.



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