Systematic review of tuberculous meningitis in high-risk populations: mortality and diagnostic disparities

Aim: Tuberculous meningitis (TBM) is one of the most severe clinical forms of tuberculosis (TB). Since epidemiological studies can contribute to TB control, we conducted a review and meta-analysis of epidemiological publications of adults TBM cases in countries with high incidence of TB. Materials & methods: The search resulted in 11,855 articles, in which 21 ultimately were included in our review and 15 in our meta-analysis. Results: TBM mortality was 25% with death rates of 70% in Africa. The review showed different and non-concordant diagnostic techniques and treatment schemes. Conclusion: Adults living in the African region are at high risk of death from TBM, highlighting an urgent need of guidelines to support diagnosis and treatment, and ultimately, to reduce mortality. Tuberculosis (TB) is a disease that mostly affects the lungs. It can also affect other organs. When TB affects the brain and spinal cord, it is called tuberculous meningitis (TBM). We looked to analyze the traits of the adults with TBM that live in countries with a high number of cases of TB. We searched scientific publications that studied these populations to find information that may help to control the disease. The death rate of TBM was 25%, reaching up to 70% in Africa. We found some disparities regarding diagnosis and treatment. Adults living in Africa have a higher risk of dying from TBM. We need guidelines about the diagnosis and treatment of TBM to help reduce TBM deaths in these countries. One of the most severe clinical forms of tuberculosis (TB) is tuberculous meningitis (TBM), which affects about 1% of the population infected with TB. The number of cases and severity of TBM is generally higher in children, but TBM also affects adults. We conduct a study investigating the prevalence of TBM and epidemiological data in the adult population at higher risk in the 30 countries with the highest incidence of TB. Relevant epidemiological publications on TBM in countries with a high incidence of tuberculosis were searched in five databases. TBM was reported with more frequency in studies in Asian and African continents. The meta-analysis shows a mortality rate of 25% in the TBM group. Africa and Taiwan studies showed death rates of 70% and 39%, respectively. Studies from Africa showed three-times as many adults with TBM died compared with any other regions studied. The diagnostic techniques and the treatment schemes showed a great variation between the studies. There is an urgent n