Do adjunctive corticosteroid and aspirin improve the outcome of tuberculous meningitis?

      Background: Corticosteroid and aspirin have been reported to improve the outcome of tuberculous meningitis (TBM) but their relative efficacy of corticosteroid, aspirin and combination of both have not been evaluated.
      Objective: To compare the outcome of patients with TBM receiving adjunctive aspirin, aspirin+ corticosteroids or none of these therapies.
      Patients and methods: In a retrospective hospital based study, consecutive patients with TBM during 2008-2014 were included after ethical clearance. The diagnosis of TBM was based on clinical, cerebrospinal fluid (CSF), MRI, AFB, ELISA and PCR findings. The severity of meningitis was graded into stage I, II and III. They received 4 drugs (HRZE) antitubercular treatment with 150 mg/day aspirin (Group I) or prednisolone (0.5mg/kg/d) for 1mo plus aspirin (Group II) or none of these adjunctive therapies (Group III). Outcome was defined at 3 months into death, poor or good.
      Results: 135 patients with TBM were included whose median age was 36.4 years and 49.6% were females. 29.6% patients had stage I meningitis, 54.8% stage II and 15.3% stage III meningitis. Group II patients had more severe illness compared to group I and III (P<0.002). At 3 months, 24% patients died; 18.2 % in group I, 18% in group II and 34.1 in group III. Complete recovery was more frequent in group II (48.8%) compared to group I (30.6%) and group III (25.9%). Death and functional outcome however were not significantly different in between the groups.
      Conclusion: Adjunctive steroid plus aspirin therapy in TBM seems to offer survival and outcome benefit.