Central nervous system tuberculosis: characteristics, risks, and outcomes in California adults, 2010-2022.

BACKGROUND: Central nervous system (CNS) tuberculosis (TB) is rare and causes substantial morbidity and mortality. We quantified the frequency, characteristics, outcomes, and risks associated with CNS TB.

METHODS: We performed a retrospective analysis of culture-confirmed TB in adults reported to the California TB Registry during 2010-2022 to compare individuals with CNS TB vs. non-CNS TB. We used a causal diagram and modified Poisson model with robust variance to estimate the adjusted relative risk of CNS TB vs. non-CNS TB among people with TB caused byvs. non-complex. We also identified risk factors for death with CNS TB.

RESULTS: There were 21,117 TB cases reported; 382 (1.8 %) involved the CNS. Compared to those without CNS TB, those with CNS TB were more likely younger, of Hispanic ethnicity, born in Mexico, infected with, co-infected with HIV, immunosuppressed, and to have had normal chest radiography. The adjusted relative risk of(vs. non-) causing CNS TB was 2.86 (95 % CI 2.04-4.02). A large number of CNS TB patients died, 108 (28.3 %). Among people with CNS TB, death was associated with older age, end-stage renal disease, and immune suppression.

CONCLUSION: More than one quarter of patients with CNS TB died. People with TB caused by, were more likely to have CNS TB than people with TB caused by non-s forms of thecomplex. Further efforts to prevent, rapidly diagnose, and effectively treat CNS TB is warranted.