Tuberculosis meningitis (TBM) is associated with significant neurological sequelae and a high mortality rate. Recent research shows a low incidence of tuberculosis in Japan; however, a few physicians have been encountering cases of TBM in clinical practice. Therefore, deeper understanding of the clinical features and disease course is important. In this study, we retrospectively investigated patients hospitalized with diagnosis of TBM at Tosei General Hospital, Seto, Japan between 2012 and 2022. Patient data including age, sex, nationalities, medical histories, initial symptoms, site of infection, major findings on brain magnetic resonance imaging (MRI), blood and cerebrospinal fluid (CSF) investigation findings, treatment, and prognosis were obtained from medical records. In total of 14 cases, mean age was 70.5 years [standard deviation 18.0 years], 6 (42.9%) were women, and 13 (92.9%) were Japanese. The most common site of active tuberculosis infection was the lungs. Disseminated tuberculosis was observed in 12 (85.7%) and urinary tract tuberculosis in 8 (66.7%) patients. Clinical symptoms on admission included headache in 6 (42.9%), systemic symptoms in 6 (42.9%), fever in 3 (21.4%), convulsions in 1 (7.1%), weight loss in 1 (7.1%), and dyspnea in 1 (7.1%) patient. Major findings on brain MRI were cerebral infarction in 5 (35.7%), tuberculomas in 5 (35.7%), and hydrocephalus in 1 (7.1%) patient. CSF analysis confirmed bacterial infection in 3 (21.4%) patients. All patients received antituberculosis drugs, and corticosteroid was administered to 12 (85.7%) patients. Median length of hospitalization was 71.5 days (interquartile range 36.81-10.5 days), 8 (57.1%) patients recovered with sequelae, 4 (28.6%) died, and 2 (14.3%) patients recovered completely. In conclusion, TBM is diagnostically challenging based on CSF analysis, and careful evaluation of symptoms, imaging findings, and the clinical course are important for accurate diagnosis. Further studies are warranted to gain deeper insight into TBM.

Objective: This study aimed to describe the impact of Clostridiodides difficile infection (CDI) on health-related quality of life (HRQoL) among hospitalized adults in Japan.

Methods: HRQoL data were collected as part of an active surveillance study conducted in nine hospitals in Ota-ku (Tokyo), Japan. Among adults aged ≥50 years with onset of ≥3 unformed stools within 24 hours and Bristol score ≥5, stool samples were collected and tested for C. difficile. EuroQOl 5-dimensions 5-levels (EQ-5D-5L) index and EQ-5D-5L visual analogue scale (EQ-VAS) data were collected at baseline and at 90-day follow-up. Descriptive statistics and paired t-tests were performed to examine change in HRQoL; EQ-5D-5L index and EQ-VAS scores of cases (CDI+) were informally compared with published Japanese population norms.

Results: Of 1,384 patients enrolled in the study, 21 (CDI+) and 39 (CDI-) completed the EQ-5D-5L measures. The EQ-5D-5L index scores for both CDI+and CDI- groups increased over time (0.63±0.30 to 0.83±0.17 and 0.60±0.30 to 0.74±0.21, respectively). Despite the observed improvement from baseline, CDI+patients possessed poorer HRQoL at both timepoints than the general Japanese population, including among adults aged 65-74 years (0.76-0.85 vs. 0.91) and among those aged ≥75 years (0.59-0.78 vs. 0.87), respectively. A similar pattern of results was also found for EQ-VAS scores.

Conclusions: Even in milder cases, CDI may be associated with impairment in HRQoL. Although a trend of improvement in HRQoL was observed, results suggest that impairment may nonetheless persist for months after CDI. These findings highlight the unmet need for public health interventions that can reduce CDI burden in Japan.