Effect Of Hepatitis B Virus Co-Infection On Tuberculous Meningitis

Background:Tuberculous meningitis(TBM)is the most severe forms of tuberculosis.Early confirmation of TBM is crucial for good outcomes,yet it is hard to be performed for reasons:there are no particular depictions of early symptoms;a rapid,sensitive and affordable diagnostics have yet to be developed.In addition,adverse reactions of drugs,like anti-tuberculosis drug-induced liver injury(ATB-DILI),lead the treatment thornier.Several studies reported that co-infection with hepatitis B virus(HBV)was one of the risk factors for ATB-DILI;however,most studies primarily focused on pulmonary tuberculosis instead of TBM.Consequently,only limited data are available on the effect of HBV on TBM.Methods:We retrospectively collected the clinical data of TBM patients admitted to Nanfang hospital from June 2002 to June 2018.Patients were divided into the HBV and non-HBV groups according to the status of HBV,and statistical analysis was used to explore the impact of HBV co-infection on TBM.Univariate and multivariate regression analysis were used to determine prognostic factors.Results:A total of 386 patients were enrolled(57 in HBV group and 329 in non-HBV group).Twenty(5.18%)patients were confirmed with definite TBM;one hundred and twenty-three(31.87%)patients were classified as probable TBM;and 243(62.95%)patients were diagnosed with possible TBM.One hundred and three(26.68%)patients showed GCS ranging from 3 to 8,and 141(36.53%)patients advanced to stage Ⅲ at admission.The main clinical symptoms included fever(88.60%),headache(88.08%),meningeal stiffness(75.13%)and nausea/vomiting(61.14%).Most of the patients showed normal blood tests at the time of admission.The main findings of baseline cerebrospinal fluid were leukocytosis(115.00(50.00,225.00)/μL),elevated protein(1.36(0.85,2.09)g/L)and decreased glucose(2.26(1.50,2.88)mmol/L).The major findings of brain imaging examination during inpatient period were tuberculoma(39.12%),basal enhancement(36.15%),infarction(22.02%)and hydrocephalus(15.03%).A total of 83(21.50%)patients suffered from poor outcomes(death during inpatient period or neurological deficit at discharge).The risk of ATB-DILI(HBV group:14.04%vs.non-HBV group:3.34%,P<0.001)and poor outcomes(HBV group:31.58%vs.non HBV group:19.76%,P=0.045)were higher in HBV group than non-HBV group.Multivariate regression analysis confirmed that ATB-DILI(OR=4.601(1.532,10.438),P<0.001),GCS=3-8(OR=2.351(1.129,3.933),P=0.001)and hydrocephalus(OR=4.320(2.209,8.449),P<0.001)were independent risk factors of poor outcomes.Conclusion:Our study demonstrated HBV co-infection could increase the incident of ATB-DILI and the risk of poor outcomes among TBM patients.In addition,we identified three independent prognostic factors that were associated with poor outcomes.