Clinical characteristics and factors associated with tuberculous meningitis outcomes in Thailand: A 13-year retrospective cohort study

BACKGROUND: Tuberculous meningitis (TBM) remains the most severe manifestation of tuberculosis. Additional work is needed to characterize clinical features and outcomes of TBM in low- and middle-income countries (LMIC). METHODS: We retrospectively identified adults with suspected TBM at King Chulalongkorn Memorial Hospital (KCMH), Bangkok, Thailand, from 2012 to 2025. TBM was categorized as definite, probable, and possible, according to the uniform case definition. Modified Rankin Scale (mRS) was assessed at discharge and 1 year. Multivariable logistic regression was used to evaluate factors associated with poor clinical outcomes, delayed presentation, and treatment initiation. RESULTS: Among 113 patients, 32.7% met criteria for definite, 23.0% probable, and 44.2% possible TBM. Median age was 43 (IQR 30-55) years; 25.7% were female, and 39.8% had HIV. Common presenting symptoms included fever (80.5%), headache (62.8%), and altered mental status (55.8%). At discharge, 47.8% had poor outcomes (mRS>2), including 10.6% mortality. Severe disease and lower albumin were associated with worse outcomes at discharge. Corticosteroid use was not associated with worse outcomes. CONCLUSIONS: TBM is common in adults presenting to a tertiary care center in Thailand, and severe features predict worse outcomes. Significant delays to presentation and treatment were observed, highlighting the importance of early diagnosis and timely treatment to improve prognosis in TBM.