Pretreatment cerebrospinal fluid bacterial load correlates with inflammatory response and predicts neurological events during tuberculous meningitis treatment

Abstract

Background The Mycobacterium tuberculosis load in the brain of individuals with tuberculous meningitis (TBM) may reflect the host's ability to control the pathogen, determine disease severity, and determine treatment outcomes. Methods We used the GeneXpert assay to measure the pretreatment M. tuberculosis load in cerebrospinal fluid (CSF) specimens from 692 adults with TBM. We sought to understand the relationship between CSF bacterial load and inflammation, and their respective impact on disease severity and treatment outcomes. Results A 10-fold higher M. tuberculosis load was associated with increased disease severity (odds ratio, 1.59; P =.001 for the comparison between grade 1 and grade 3 severity), CSF neutrophil count (r = 0.364 and P