HIV–A prognostic factor of tuberculous meningitis: A retrospective cohort study among adults in peninsular Malaysia
King-Fang Tan 1 , Nyi Nyi Naing 2 , Nadiah Wan-Arfah 3 * , John Tharakan 4 , Hanip Rafia 5 , Irfhan Ali Hyder Ali 6 , Noor Aliza Tarekh 7 , Vetriselvan Subramaniyan 8 9 , Ling Shing Wong 10 * , Siddharthan Selvaraj 11 12
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1 Sultan Azlan Shah Training Institute of Ministry of Health Malaysia, Ministry of Health Malaysia, Perak, MALAYSIA2 Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu, Terengganu, MALAYSIA3 Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Kuala Terengganu, Terengganu, MALAYSIA4 Department of Neurosciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, MALAYSIA5 Department of Neurology, Hospital Kuala Lumpur, Ministry of Health Malaysia, Wilayah Persekutuan, Kuala Lumpur, MALAYSIA6 Department of Respiratory, Hospital Pulau Pinang, Ministry of Health Malaysia, Pulau Pinang, MALAYSIA7 Department of Respiratory, Hospital Sultanah Aminah, Ministry of Health Malaysia, Johor Bahru, Johor, MALAYSIA8 Pharmacology Unit, Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500 Selangor Darul Ehsan, MALAYSIA9 Center for Transdisciplinary Research, Department of Pharmacology, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, 600077, INDIA10 Faculty of Health and Life Sciences, INTI International University, Nilai, MALAYSIA11 Faculty of Dentistry, AIMST University, Bedong, Kedah, MALAYSIA12 Centre for Global Health Research, Saveetha Medical College and Hospital, Chennai, Tamil Nadu, INDIA* Corresponding Author


Background: Tuberculous meningitis is a major public health issue, despite showing low incidence, tuberculous meningitis causes substantial mortality. For better clinical management, identification of prognostic factors is crucial to reduce health risk of Malaysian society. Therefore, the aim of this study was to determine the prognostic factors of adult tuberculous meningitis in peninsular Malaysia.
Materials & methods: Initially, a retrospective cohort study and one-year of follow-up period was carried out. In addition, a total of 217 adult tuberculous meningitis patients treated or had follow-up in four tertiary hospitals in peninsular Malaysia were recruited. Cox proportional hazards regression was employed to perform multivariable analysis.
Results: The overall survival probability of adult tuberculous meningitis was 36.8% with median survival time 244 days. Significant prognostic factors were Glasgow coma scale score (aHR=0.71, 95% CI=0.65, 0.76; p<0.001), HIV status (aHR=1.94, 95% confidence interval [CI]=1.19, 3.15; p=0.008), headache (aHR=0.48, 95% CI=0.31, 0.76; p=0.002) and meningeal enhancement (aHR=0.47, 95% CI=0.30, 0.74; p=0.001), nausea (aHR=2.21, 95% CI=1.33, 3.66; p=0.002), and vomit (aHR=0.58, 95% CI=0.36, 0.93; p=0.023).
Conclusions: Evidently, the survival of among adults with tuberculous meningitis was low. Since HIV positive has a significant influence in mortality; early screening, diagnosis, and prompt treatment in this subgroup of patients play a key role in survival.


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Article Type: Original Article

ELECTRON J GEN MED, 2024, Volume 21, Issue 2, Article No: em579

Publication date: 25 Mar 2024

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