Fatal tuberculous meningitis caused by immune restoration disease

Huttner, Hagen B.; Kollmar, Rainer; Hug, Andreas; Meisel, F.; Kress, Bodo; Schwab, Stefan

doi:10.1007/s00415-004-0563-4

Cited by 5 publications

(4 citation statements)

References 14 publications

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“…Infective forms of immune reconstitution inflammatory syndromes may manifest as either an inflammatory ‘unmasking’ of previously untreated tuberculosis or as the paradoxical clinical deterioration of tuberculous meningitis (92, 94). Immune reconstitution inflammatory syndrome may be severe enough to cause death (95).…”

Section: Tuberculous Meningitis and Human Immunodeficiency Virusmentioning

confidence: 99%

Tuberculous meningitis

Garg

2009

Acta Neurologica Scandinavica

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Tuberculous meningitis is a severe form of extrapulmonary tuberculosis. The exact incidence and prevalence are not known. In countries with high burden of pulmonary tuberculosis, the incidence is expected to be proportionately high. Children are much more vulnerable. Human immunodeficiency virus-infected patients have a high incidence of tuberculous meningitis. The hallmark pathological processes are meningeal inflammation, basal exudates, vasculitis and hydrocephalus. Headache, vomiting, meningeal signs, focal deficits, vision loss, cranial nerve palsies and raised intracranial pressure are dominant clinical features. Diagnosis is based on the characteristic clinical picture, neuroimaging abnormalities and cerebrospinal fluid changes (increased protein, low glucose and mononuclear cell pleocytosis). Cerebrospinal fluid smear examination, mycobacterial culture or polymerase chain reaction is mandatory for bacteriological confirmation. The mortality and morbidity of tuberculous meningitis are exceptionally high. Prompt diagnosis and early treatment are crucial. Decision to start antituberculous treatment is often empirical. WHO guidelines recommend a 6 months course of antituberculous treatment; however, other guidelines recommend a prolonged treatment extended to 9 or 12 months. Corticosteroids reduce the number of deaths. Resistance to antituberculous drugs is associated with a high mortality. Patients with hydrocephalus may need ventriculo-peritoneal shunting. Bacillus Calmette-Guérin vaccination protects to some degree against tuberculous meningitis in children.

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Section: Tuberculous Meningitis and Human Immunodeficiency Virusmentioning

confidence: 99%

Tuberculous meningitis

Garg

2009

Acta Neurologica Scandinavica

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“…In many cases, immune reconstitution syndrome may be mild and resolve without treatment. Deaths, however, have been reported, particularly in cases in which there is CNS involvement with progressive multifocal leukoencephalopathy or infection with Cryptococcus species or Mycobacterium tuberculosis [3][4][5]. Because the manifestations of immune reconstitution syndrome vary widely, depending on the target to which the restored inflammatory response is directed, it is difficult to describe as a single clinical entity.…”

mentioning

confidence: 99%

Immune Reconstitution Syndrome in HIV: Validating a Case Definition and Identifying Clinical Predictors in Persons Initiating Antiretroviral Therapy

Robertson¹,

Meier²,

Wall³

et al. 2006

Clinical Infectious Diseases

181

121

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“…There may be some debate regarding the accuracy of some of the reports, as, at times, any condition that occurs after the initiation of HAART is labeled as IRIS 66 . Cohort studies have reported an incidence of dermatologic manifestations of IRIS between 52% and 78% 67–69 . Herpes zoster virus and herpes simplex virus infections are the most frequent forms of dermatologic IRIS 67,70 .…”

Section: Immune Reconstitution Inflammatory Syndromementioning

confidence: 99%

“…Cohort studies have reported an incidence of dermatologic manifestations of IRIS between 52% and 78% 67–69 . Herpes zoster virus and herpes simplex virus infections are the most frequent forms of dermatologic IRIS 67,70 . With the increasing availability of HAART worldwide in resource‐limited countries, the spectrum of infections associated with IRIS will increase further, as patients in these settings typically enter HAART at advanced disease stages, often with a high burden of endemic opportunistic infections.…”

Section: Immune Reconstitution Inflammatory Syndromementioning

confidence: 99%

Current status of HIV infection: a review for non‐HIV‐treating physicians

2007

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An estimated 40 million people live with human immunodeficiency virus (HIV) globally, and over four million people were newly diagnosed with HIV infection in 2006. Twenty-five million people have died as a result of HIV since its recognition in 1981. Where available, highly active antiretroviral therapy has resulted in significant decreases in HIV-associated morbidity and mortality. Nevertheless, opportunistic infections and conditions continue to occur, and their recognition and management continue to be an important component of HIV care.

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Fatal tuberculous meningitis caused by immune restoration disease

Cited by 5 publications

References 14 publications

Tuberculous meningitis

Tuberculous meningitis

Immune Reconstitution Syndrome in HIV: Validating a Case Definition and Identifying Clinical Predictors in Persons Initiating Antiretroviral Therapy

Current status of HIV infection: a review for non‐HIV‐treating physicians

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