{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T15:48:57Z","timestamp":1791906537792,"version":"4.3.4"},"reference-count":32,"publisher":"American Society of Tropical Medicine and Hygiene","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,13]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>\n                    Tuberculous meningitis (TBM) is the most severe form of extrapulmonary tuberculosis, carrying the highest mortality among all forms. This multicentric prospective cohort study conducted in North India aimed to determine the incidence of complications, functional outcome (modified Rankin scale [mRS]), and mortality in TBM. Patients 12 years old and older with TBM were followed up until completion of 9 months of antitubercular treatment. Patients with concomitant HIV infection, other infections causing meningitis, or multidrug-resistant tuberculosis were excluded. The primary outcome was mRS at 9 months. Secondary outcomes included mRS at 6 months, poor mRS (&gt;2), Barthel Index, and mortality at 6 and 9 months. Between October 1, 2019 and March 31, 2024, 585 eligible patients were enrolled, of whom 495 (84.6%) completed follow-up. The median age was 24.0 years old, and the majority were female (\n                    <jats:italic>n<\/jats:italic>\n                    = 304\/495; 61.4%). Complications were present in 377 patients (76.2%): focal neurological deficits (41.6%), seizures (38.6%), immune reconstitution inflammatory syndrome (32.7%), hydrocephalus (24.8%), and drug-induced liver injury (14.1%). Complications were associated with worse mRS on unadjusted analysis (odds ratio [OR]: 2.5 [1.7\u20133.7];\n                    <jats:italic>P<\/jats:italic>\n                    &lt;0.001); however, this association was no longer statistically significant after adjustment for age, sex, baseline mRS, study center, and disease stage and category (OR: 1.3 [0.8\u20132.0];\n                    <jats:italic>P<\/jats:italic>\n                    = 0.30). The median mRS improved from 4.0 at presentation to 2.0 at 6 months and 1.0 at 9 months. Death occurred at a median of 91.0 days after presentation. Mortality at 6 months was 9.3% and at 9 months was 10.7%.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.26-0194","type":"journal-article","created":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T15:20:45Z","timestamp":1791904845000},"source":"Crossref","is-referenced-by-count":0,"title":["Outcomes in Patients with Tuberculous Meningitis: A Prospective Cohort Study in North India"],"prefix":"10.4269","author":[{"given":"Deepti","family":"Vibha","sequence":"first","affiliation":[{"name":"All India Institute of Medical Sciences, New Delhi, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suman","family":"Kushwaha","sequence":"additional","affiliation":[{"name":"Institute of Human Behavior and Allied Sciences, New Delhi, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shishir Kumar","family":"Chandan","sequence":"additional","affiliation":[{"name":"Vardhman Mahavir Medical College, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manabesh","family":"Nath","sequence":"additional","affiliation":[{"name":"All India Institute of Medical Sciences, New Delhi, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wajid","family":"Rafi","sequence":"additional","affiliation":[{"name":"All India Institute of Medical Sciences, New Delhi, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajesh Kumar","family":"Singh","sequence":"additional","affiliation":[{"name":"All India Institute of Medical Sciences, New Delhi, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Awadh Kishor","family":"Pandit","sequence":"additional","affiliation":[{"name":"All India Institute of Medical Sciences, New Delhi, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhargavi","family":"Ramanujam","sequence":"additional","affiliation":[{"name":"All India Institute of Medical Sciences, New Delhi, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Divya M.","family":"Radhakrishnan","sequence":"additional","affiliation":[{"name":"All India Institute of Medical Sciences, New Delhi, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Animesh","family":"Das","sequence":"additional","affiliation":[{"name":"All India Institute of Medical Sciences, New Delhi, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arunmozhimaran","family":"Elavarasi","sequence":"additional","affiliation":[{"name":"All India Institute of Medical Sciences, New Delhi, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sada Nand","family":"Dwivedi","sequence":"additional","affiliation":[{"name":"All India Institute of Medical Sciences, New Delhi, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Achal Kumar","family":"Srivastava","sequence":"additional","affiliation":[{"name":"All India Institute of Medical Sciences, New Delhi, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manjari","family":"Tripathi","sequence":"additional","affiliation":[{"name":"All India Institute of Medical Sciences, New Delhi, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kameshwar","family":"Prasad","sequence":"additional","affiliation":[{"name":"All India Institute of Medical Sciences, New Delhi, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"issue":"10","key":"b1","series-title":"Nat Rev Neurol","first-page":"581","article-title":"Tuberculous meningitis","volume":"13","author":"Wilkinson","year":"2017"},{"issue":"8","key":"b2","series-title":"Open Forum Infect Dis","first-page":"ofaa257","article-title":"Treatment outcomes in adult tuberculous meningitis: A systematic review and meta-analysis","volume":"7","author":"Stadelman","year":"2020"},{"issue":"5","key":"b3","series-title":"Intern Med J","first-page":"802","article-title":"Incidence, risk factors and treatment of central nervous system immune reconstitution inflammatory syndrome in non-HIV patients with tuberculous meningitis: A multicentre observational study","volume":"54","author":"Robert","year":"2024"},{"issue":"4","key":"b4","series-title":"Curr Opin Neurol","first-page":"406","article-title":"Tuberculosis of the central nervous system: Current concepts in diagnosis and treatment","volume":"38","author":"Garg","year":"2025"},{"issue":"6","key":"b5","series-title":"PLoS One","first-page":"e0270201","article-title":"Long term outcomes of patients with tuberculous meningitis: The impact of drug resistance","volume":"17","author":"Evans","year":"2022"},{"issue":"3","key":"b6","series-title":"Acta Neurol Belg","first-page":"821","article-title":"Occurrence and determinants of seizures and their impact on tuberculous meningitis: A prospective evaluation","volume":"124","author":"Kirar","year":"2024"},{"key":"b7","series-title":"BMC Infect Dis","first-page":"306","article-title":"Paradoxical reaction in tuberculous meningitis: Presentation, predictors and impact on prognosis","volume":"16","author":"Singh","year":"2016"},{"key":"b8","series-title":"World Neurosurg","first-page":"123562","article-title":"Prognostic model to predict outcome of adult patients with tuberculous meningitis undergoing ventriculoperitoneal shunt surgery: A prospective observational study","volume":"194","author":"Hasib","year":"2025"},{"key":"b9","series-title":"Front Neurol","first-page":"830029","article-title":"Myelitis: A common complication of tuberculous meningitis predicting poor outcome","volume":"13","author":"Jiang","year":"2022"},{"key":"b10","series-title":"Clin Neurol Neurosurg","first-page":"29","article-title":"Clinical and radiological predictors of outcome in tubercular meningitis: A prospective study of 209 patients","volume":"161","author":"Modi","year":"2017"},{"issue":"2","key":"b11","series-title":"Lancet Infect Dis","first-page":"e96","article-title":"A clinical practice guideline for tuberculous meningitis","volume":"26","author":"Donovan","year":"2026"},{"key":"b12","article-title":"Index\u2014TB Guidelines","year":"2026"},{"key":"b13","series-title":"Cochrane Database Syst Rev","first-page":"CD012091","article-title":"Six months therapy for tuberculous meningitis","volume":"9","author":"Jullien","year":"2016"},{"key":"b14","article-title":"Search Result, Clinical Trials Registry\u2014India (CTRI)","year":"2026"},{"issue":"11","key":"b15","series-title":"Lancet Infect Dis","first-page":"803","article-title":"Tuberculous meningitis: A uniform case definition for use in clinical research","volume":"10","author":"Marais","year":"2010"},{"issue":"17","key":"b16","series-title":"N Engl J Med","first-page":"1741","article-title":"Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults","volume":"351","author":"Thwaites","year":"2004"},{"key":"b17","article-title":"What Is \u201cUrban\/Rural\u201d India?","author":"Ravi","year":"2023"},{"key":"b18","article-title":"WHO Housing and Health Guidelines: Recommendations to Promote Healthy Housing for a Sustainable and Equitable Future","year":"2018"},{"key":"b19","series-title":"Indian J Med Res","first-page":"81","article-title":"Evaluation of risk factors for antituberculosis treatment induced hepatotoxicity","volume":"132","author":"Singla","year":"2010"},{"issue":"11","key":"b20","series-title":"Int J Tuberc Lung Dis","first-page":"1194","article-title":"Complications of tuberculous meningitis and their effect on outcome in a tertiary care cohort","volume":"24","author":"Misra","year":"2020"},{"issue":"3","key":"b21","series-title":"Curr Treat Options Neurol","first-page":"5","article-title":"Treatment of tuberculous meningitis and its complications in adults","volume":"20","author":"Davis","year":"2018"},{"key":"b22","series-title":"J Neurol Sci","first-page":"460","article-title":"Neurological complications after tuberculous meningitis in a multi-state cohort in the United States","volume":"375","author":"Merkler","year":"2017"},{"issue":"9","key":"b23","series-title":"J Clin Neurosci","first-page":"1114","article-title":"Neurological and systemic complications of tuberculous meningitis and its treatment at Auckland City Hospital, New Zealand","volume":"17","author":"Anderson","year":"2010"},{"issue":"12","key":"b24","series-title":"Open Forum Infect Dis","first-page":"ofad559","article-title":"Central nervous system tuberculosis: Risk factors for mortality in a propensity score\u2013matched case-control study","volume":"10","author":"Asare-Baah","year":"2023"},{"issue":"1","key":"b25","series-title":"BMC Infect Dis","first-page":"656","article-title":"Analysis of risk factors for long-term mortality in patients with stage II and III tuberculous meningitis","volume":"24","author":"Wang","year":"2024"},{"key":"b26","series-title":"J Neurol Sci","first-page":"121356","article-title":"Determinants of one year outcome of central nervous system (CNS) tubercular mass lesions: An ambispective cohort study","volume":"455","author":"Vibha","year":"2023"},{"issue":"2","key":"b27","series-title":"Am J Trop Med Hyg","first-page":"357","article-title":"Early mortality among immunocompetent patients of tuberculous meningitis: A prospective study","volume":"101","author":"Jaipuriar","year":"2019"},{"issue":"4","key":"b28","series-title":"Neurol India","first-page":"993","article-title":"Role of aspirin in tuberculous meningitis: A systematic review and meta-analysis","volume":"67","author":"Rizvi","year":"2019"},{"issue":"4","key":"b29","series-title":"Int J Tuberc Lung Dis","first-page":"486","article-title":"Predictors of paradoxical tuberculoma in tuberculous meningitis","volume":"18","author":"Kalita","year":"2014"},{"issue":"8","key":"b30","series-title":"Antimicrob Agents Chemother","first-page":"e0014021","article-title":"Plasma pharmacokinetics of high-dose oral versus intravenous rifampicin in patients with tuberculous meningitis: A randomized controlled trial","volume":"65","author":"Wasserman","year":"2021"},{"key":"b31","series-title":"Wellcome Open Res","first-page":"32","article-title":"Adjunctive dexamethasone for the treatment of HIV-uninfected adults with tuberculous meningitis stratified by Leukotriene A4 hydrolase genotype (LAST ACT): Study protocol for a randomised double blind placebo controlled non-inferiority trial","volume":"3","author":"Donovan","year":"2018"},{"key":"b32","series-title":"New Microbes New Infect","first-page":"101623","article-title":"Anti-TB treatment outcomes in TB meningitis: A systematic review and meta-analysis","volume":"67","author":"Afazel","year":"2025"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/aop\/article-10.4269-ajtmh.26-0194\/article-10.4269-ajtmh.26-0194.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/aop\/article-10.4269-ajtmh.26-0194\/article-10.4269-ajtmh.26-0194.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T15:20:46Z","timestamp":1791904846000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/aop\/article-10.4269-ajtmh.26-0194\/article-10.4269-ajtmh.26-0194.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,13]]},"references-count":32,"URL":"https:\/\/doi.org\/10.4269\/ajtmh.26-0194","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,13]]}}}