Meningitis tuberculosa: estudio comparativo en relación con la coexistencia de infección por el virus de la inmunodeficiencia humana

Azuaje, Carlos; Fernández-Hidalgo, Núria; Almirante, Benito; Casabona, Núria Martín; Ribera, Esteban; Díaz, M. Medina; Prats, Guillem; Pahissa, Albert

doi:10.1016/s0213-005x(06)73770-3

Cited by 15 publications

(4 citation statements)

References 22 publications

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“…One multicenter cohort study also included diabetes mellitus, hydrocephalus, and vasculitis as prognostic factors (HAMSI scale), and one category included HIV patients with low CD4 counts [15]. Our study confirmed other previously reported findings including no significant differences in CSF characteristics (protein, WBC count and glucose) between patients with and without HIV co-infection, higher likelihood for HIV-infected patients having had extrapulmonary TB, and a higher percentage of extrapulmonary TB presenting as TBM [6, 16]. Although concomitant pulmonary TB was more common in HIV-infected patients (32.6% vs. 29.3%; p = 0.4), it was not associated with increased mortality nor with degree of immunosuppression, as measured by CD4 cell count, though it should be taken into consideration that the majority of patients in both the deceased and living groups had CD4 counts less than 200.…”

Section: Discussionsupporting

confidence: 86%

Mortality in hospitalized patients with tuberculous meningitis

et al. 2019

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BackgroundTo evaluate the mortality in hospitalized patients with tuberculous meningitis and describe factors associated with an increased risk of mortality.MethodsRetrospective study of hospitalized patients with tuberculous meningitis between 2006 and 2015 in Peru performing a generalized linear regression to identify factors predictive of in-hospital mortality.ResultsOf 263 patients, the median age was 35 years, 72.6% were men, 38% were positive for HIV upon admission, 24% had prior TB infections and 2.3% had prior MDR-TB infections. In-hospital mortality was 30.4% of all study patients with a final diagnosis of TBM. When multivariable analysis was applied, significant associations with in-hospital mortality were seen among patients with HIV (RR 2.06; Confidence Interval 95% (95% CI) 1.44–2.94), BMRC II (RR 1.78; 95% CI 1.07–2.97), BMRC III (RR 3.11; 95% CI 1.78–5.45) and positive CSF cultures (RR 1.95; 95% CI 1.39–2.74).ConclusionsIn-hospital mortality is higher among patients with HIV infections, age over 40 years, positive CSF TB culture and BMRC stage II or III.

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Section: Discussionsupporting

confidence: 86%

Mortality in hospitalized patients with tuberculous meningitis

et al. 2019

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“…Most studies published to date have been small, retrospective and have compared the clinical features of TBM in HIV-infected and uninfected patients. Some studies have reported that HIV infection does not alter the presenting clinical features of TBM [28], [29], whereas others have suggested that HIV infection is associated with a higher rate of extra-pulmonary disease [30], extra-meningeal disease [31], [32] and radiological abnormalities on cranial imaging [32] …”

Section: Discussionmentioning

confidence: 99%

Clinical and Microbiological Features of HIV-Associated Tuberculous Meningitis in Vietnamese Adults

et al. 2008

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MethodsThe aim of this prospective, observational cohort study was to determine the clinical and microbiological features, outcome, and baseline variables predictive of death, in Vietnamese adults with HIV-associated tuberculous meningitis (TBM). 58 patients were admitted to the Hospital for Tropical Diseases in Ho Chi Minh City and underwent routine clinical and laboratory assessments. Treatment was with standard antituberculous therapy and adjunctive dexamethasone; antiretroviral therapy was not routinely available. Patients were followed up until the end of TB treatment or death.ResultsThe median symptom duration was 11 days (range 2–90 days), 21.8% had a past history of TB, and 41.4% had severe (grade 3) TBM. The median CD4 count was 32 cells/mm3. CSF findings were as follows: median leucocyte count 438×109cells/l (63% neutrophils), 69% smear positive and 87.9% culture positive. TB drug resistance rates were high (13% mono-resistance 32.6% poly-resistance 8.7% multidrug resistance). 17% patients developed further AIDS-defining illnesses. 67.2% died (median time to death 20 days). Three baseline variables were predictive of death by multivariate analysis: increased TBM grade [adjusted hazard ratio (AHR) 1.73, 95% CI 1.08–2.76, p = 0.02], lower serum sodium (AHR 0.93, 95% CI 0.89 to 0.98, p = 0.002) and decreased CSF lymphocyte percentage (AHR 0.98, 95% CI 0.97 to 0.99, p = 0.003).ConclusionsHIV-associated TBM is devastating disease with a dismal prognosis. CSF findings included CSF neutrophil predominance, high rates of smear and culture positivity, and high rates of antituberculous drug resistance. Three baseline variables were independently associated with death: increased TBM grade; low serum sodium and decreased CSF lymphocyte percentage.

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“…Further, those who survive TBM are usually left with severe neurological defects [3-5]. There is an increased risk of TBM in HIV-infected patients as compared to non-HIV infected cases although the clinical manifestations of the disease do not differ between the two groups [6,7]. …”

Section: Introductionmentioning

confidence: 99%

Quantitative proteomics for identifying biomarkers for tuberculous meningitis

et al. 2012

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IntroductionTuberculous meningitis is a frequent extrapulmonary disease caused by Mycobacterium tuberculosis and is associated with high mortality rates and severe neurological sequelae. In an earlier study employing DNA microarrays, we had identified genes that were differentially expressed at the transcript level in human brain tissue from cases of tuberculous meningitis. In the current study, we used a quantitative proteomics approach to discover protein biomarkers for tuberculous meningitis.MethodsTo compare brain tissues from confirmed cased of tuberculous meningitis with uninfected brain tissue, we carried out quantitative protein expression profiling using iTRAQ labeling and LC-MS/MS analysis of SCX fractionated peptides on Agilent’s accurate mass QTOF mass spectrometer.Results and conclusionsThrough this approach, we identified both known and novel differentially regulated molecules. Those described previously included signal-regulatory protein alpha (SIRPA) and protein disulfide isomerase family A, member 6 (PDIA6), which have been shown to be overexpressed at the mRNA level in tuberculous meningitis. The novel overexpressed proteins identified in our study included amphiphysin (AMPH) and neurofascin (NFASC) while ferritin light chain (FTL) was found to be downregulated in TBM. We validated amphiphysin, neurofascin and ferritin light chain using immunohistochemistry which confirmed their differential expression in tuberculous meningitis. Overall, our data provides insights into the host response in tuberculous meningitis at the molecular level in addition to providing candidate diagnostic biomarkers for tuberculous meningitis.

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Meningitis tuberculosa: estudio comparativo en relación con la coexistencia de infección por el virus de la inmunodeficiencia humana

Cited by 15 publications

References 22 publications

Mortality in hospitalized patients with tuberculous meningitis

Mortality in hospitalized patients with tuberculous meningitis

Clinical and Microbiological Features of HIV-Associated Tuberculous Meningitis in Vietnamese Adults

Quantitative proteomics for identifying biomarkers for tuberculous meningitis

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