Predictors of poor outcomes in neuroleptospirosis and differentiation from tuberculous meningitis: a cross-sectional analysis.

Purpose: This study was performed to identify predictors of poor outcomes in neuroleptospirosis and delineate key clinical, laboratory, and imaging parameters that differentiate it from tuberculous meningitis (TBM). Methods: This cross-sectional study included 50 patients with neuroleptospirosis and 150 with TBM at a tertiary care center in North India (2021-2023). Data on demographics, clinical features, cerebrospinal fluid (CSF) profiles, and neuroimaging findings were analyzed. Statistical comparisons were performed using independent t-tests and the Fisher exact test. Results: Neuroleptospirosis patients had significantly lower CSF protein (89.00 ± 63.89 vs 172.00 ± 145.17 mg/dL, p < 0.001), higher CSF glucose (74.20 ± 30.22 vs 47.00 ± 21.81 mg/dL, p < 0.001), and fewer magnetic resonance imaging abnormalities (eg, infarct: 2% vs 51%, p < 0.001). Fever, headache, and neck stiffness were less common in neuroleptospirosis (p < 0.001). Age and CSF cell counts showed marginal differences (p = 0.054 and p = 0.071, respectively). Mortality and severe disability were associated with older age, hypoalbuminemia, and delayed hospitalization. Conclusion: Distinct CSF profiles and neuroimaging patterns can differentiate neuroleptospirosis from TBM. Early clinical recognition of these parameters should improve diagnostic accuracy and outcomes.