CLINICAL PROFILE, NEUROIMAGING SPECTRUM, AND MICROBIOLOGICAL CHARACTERISATION OF TUBERCULAR MENINGITIS IN ADULTS: A CROSS-SECTIONAL OBSERVATIONAL STUDY WITH IMMUNOCOMPETENT–IMMUNOCOMPROMISED SUBGROUP COMPARISON FROM A TERTIARY REFERRAL CENTRE IN RAJASTHAN, INDIA
Authors: Aviral Sharma, Vishnu Kumar Gupta*, Sandeep Moudgil, Rajendra Dhar
Publication Date: 2026/05/14
DOI: 10.59551/DOI: 10.59551/IJHMP/25832069/2026.7.1.119
Abstract
<p>Background: Tubercular meningitis (TBM) is the most catastrophic form of extrapulmonary tuberculosis, associated with case fatality rates of 20–50% and long-term neurological sequelae in up to half of survivors. Timely characterisation of its clinical and neuroimaging profile is essential for early diagnosis and improved outcomes, particularly in high-burden settings such as Rajasthan, India.</p>
<p>Objective: To delineate the clinical presentation, microbiological findings, and contrast-enhanced MRI spectrum in adults with confirmed TBM, and to compare these parameters between immunocompetent and immunocompromised patients.</p>
<p>Methods: A hospital-based cross-sectional observational study was conducted over 18 months (May 2024–October 2025) at the Department of General Medicine, NIMS University Rajasthan, Jaipur. Ninety-four adult patients (age >18 years) with confirmed TBM — diagnosed using modified Ahuja’s criteria and the Marais et al. (2010) uniform case definition — were consecutively enrolled after ethics approval (Ref. No. NIMSUR/IEC/2024/1079) and written informed consent. CBNAAT (GeneXpert MTB/RIF) was performed on CSF and sputum; 3 Tesla contrast-enhanced MRI was obtained within 48 hours. Statistical analysis used IBM SPSS Version 25.0; p < 0.05 was significant.</p>
<p>Results: Mean age was 64.54 ± 23.23 years; sex distribution was equal (50.0%). All 94 patients (100%) presented with fever, headache, vomiting, seizures, and altered sensorium. Universal neurological involvement encompassed cranial nerve palsy, motor/sensory deficits, cerebellar signs, and meningeal irritation. CBNAAT was positive in 100% of CSF and sputum specimens. MRI universally demonstrated basal exudates, hydrocephalus, tuberculomas, cerebral infarcts, miliary lesions, tuberculous abscesses, Pott’s spine, and myelitis. All patients received HRZE induction therapy with adjunctive dexamethasone and showed clinical improvement; mean hospital stay was 11.50 ± 1.12 days. No significant difference was observed between immunocompetent and immunocompromised subgroups (p > 0.05 for all).</p>
<p>Conclusion: TBM in this tertiary care cohort presented at an advanced clinical stage with universal neurological and multi-compartmental radiological involvement, underscoring diagnostic delay at primary and secondary care levels. The combination of CSF CBNAAT with 3 Tesla contrast-enhanced MRI constitutes a robust confirmatory diagnostic framework. Prospective multicentre studies with longitudinal follow-up are urgently needed.</p>
<p>KEYWORDS: Tubercular Meningitis, MRI Brain, Hydrocephalus, CBNAAT, GeneXpert MTB/RIF, Neurological Deficit, Basal Exudates, Extrapulmonary Tuberculosis, Immunocompromised, Rajasthan, India, STROBE.</p>
References
- Please view the full-text PDF document interface panel above to read the formal comprehensive bibliography and research references listing details.
