Tuberculous meningitis in the elderly.

Objective Although the elderly population remains at high risk for tuberculosis, studies addressing tuberculous meningitis (TBM) in this age group are scarce. The present study aimed to evaluate the spectrum and outcome of geriatric TBM and document differences between older and young patients. Methods A prospective cohort study was conducted in the adult TBM patients admitted at PGIMER, Chandigarh (India). Consecutive older patients aged 60 years and above were enrolled from January 2019 to December 2020, and young adults aged 18-59 years were enrolled from July 2019 to December 2019. Results Fifty-five older patients with a mean age of 66.6 years and 73 young patients with a mean age of 35.1 years were enrolled. At admission, older patients were more likely to have altered mental status (96.4% versus 78.1%, P- 0.003) and advanced disease with British medical research council staging 2 or 3 (98.2% versus 89.0%, P- 0.043); however, headache (38.2% versus 67.1%, P- 0.001), vomiting (18.2% versus 35.6%, P- 0.030) and fever (80.0% versus 91.8%, P- 0.052) were less common. Cerebrospinal fluid abnormalities were less marked in older patients, with a significant difference in median total cells (70/μL versus 110/μL, P- 0.013). Hydrocephalous and infarct were common neuroimaging abnormalities in both groups; however, tuberculomas were significantly less in the elderly (15.1% versus 35.2%, P- 0.012). Older patients had a significantly low survival rate (56.4% versus 76.7%, P-0.021). Conclusion Significant differences in clinical, cerebrospinal fluid and radiological characteristics exist between elderly and young TBM patients, with survival remains dismal in the elderly.