Tuberculous meningitis in HIV-infected patients: drug susceptibility and clinical outcome

Cecchini, Diego; Ambrosioni, Juan; Brezzo, Clarisa; Corti, Marcelo; Rybko, A.; Perez, Marcela; Poggi, Susana; Ambroggi, Marta

doi:10.1097/qad.0b013e328012b84d

Cited by 43 publications

(37 citation statements)

References 8 publications

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“…Ten isolates had isolated resistance to single antituberculosis drugs. Because of multidrug-resistant strains, tuberculous meningitis was more frequent in patients who received irregular antituberculosis treatment [59,60]. Patients with multidrug-resistant tuberculous meningitis and HIV-infection have lower cure rates and higher mortality rates than patients with drug-susceptible tuberculous meningitis, and most patients die within 3 months [26,61].…”

Section: Drug-resistant Tuberculous Meningitis In Hiv-positive Patientsmentioning

confidence: 99%

Tuberculous meningitis in patients infected with human immunodeficiency virus

Garg

Sinha

2010

J Neurol

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Tuberculosis is the most common opportunistic infection in human immunodeficiency virus (HIV) infected persons. HIV-infected patients have a high incidence of tuberculous meningitis as well. The exact incidence and prevalence of tuberculous meningitis in HIV-infected patients are not known. HIV infection does not significantly alter the clinical manifestations, laboratory, radiographic findings, or the response to therapy. Still, some differences have been noted. For example, the histopathological examination of exudates in HIV-infected patients shows fewer lymphocytes, epithelioid cells, and Langhan's type of giant cells. Larger numbers of acid-fast bacilli may be seen in the cerebral parenchyma and meninges. The chest radiograph is abnormal in up to 46% of patients with tuberculous meningitis. Tuberculous meningitis is likely to present with cerebral infarcts and mass lesions. Cryptococcal meningitis is important in differential diagnosis. The recommended duration of treatment in HIV-infected patients is 9-12 months. The benefit of adjunctive corticosteroids is uncertain. Antiretroviral therapy and antituberculosis treatment should be initiated at the same time, regardless of CD4 cell counts. Tuberculous meningitis may be a manifestation of paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome. Some studies have demonstrated a significant impact of HIV co-infection on mortality from tuberculous meningitis. HIV-infected patients with multidrug-resistant tuberculous meningitis have significantly higher mortality. The best way to prevent HIV-associated tuberculous meningitis is to diagnose and isolate infectious cases of tuberculosis promptly and administer appropriate treatment.

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Section: Drug-resistant Tuberculous Meningitis In Hiv-positive Patientsmentioning

confidence: 99%

Tuberculous meningitis in patients infected with human immunodeficiency virus

Garg

Sinha

2010

J Neurol

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“…In HIV infected patients, a lower CD4 cell counts [3,23], focal signs and altered consciousness on admission, were found to be a factor associated with poor prognosis [47]. Previous study found also an association between immune suppression, neurological deterioration at admission and poor prognosis in HIV infected TBM patients [6,48,49]. Some studies reported other factors associated with death including disease duration of more than 14 days, drug resistance TB and low serum sodium concentration [23,49].…”

Section: Issn: 2373-8995mentioning

confidence: 97%

Tuberculous Meningitis in Patients Living with HIV

ELFane¹

2017

J Neurol Neurosurg

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Background: Tuberculosis Meningitis (TBM) is a devastating manifestation of tuberculosis (TB) caused by the hematogenous spread of Mycobacterium tuberculosis. TBM is particularly severe in HIV infected patients. In Morocco, TB and HIV are the main public health problems; the rate of TBM has not been well defined. The objective of this study was to describe the presentation and outcome of TBM during HIV infection in our department.

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“…The convergence of drug-resistant TB and HIV poses unique clinical challenges [1][2][3] ; among these, involvement of the central nervous system (CNS) presents one of the most difficult manifestations, with significant morbidity and mortality. [4][5][6][7] The emergence of HIV and drug-resistant TB as relentless forces in the TB epidemic has accelerated the push for innovative TB diagnostics. [8][9][10][11] The ideal method must diagnose TB from smear-negative specimens, identify resistance to at least INH and RIF, and perform under basic laboratory conditions at minimal cost.…”

Section: Discussionmentioning

confidence: 99%

Challenges of Diagnosis and Management of Tuberculosis and HIV Coinfection in Resource-Limited Settings: A Case Report from Lima, Peru

Rojas

Solari

Herrera³

et al. 2008

Journal of the International Association of Physicians in AIDS

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We present a Peruvian human immunodeficiency virus (HIV)-positive patient receiving first-line therapy for tuberculosis who presents with neurological complications to highlight some of the major issues in the diagnosis and management of human immunodeficiency virus-related central nervous system complications in resource-poor settings. These include limited options for diagnosing extrapulmonary and drug-resistant tuberculosis; the importance of central nervous system imaging; and the management conundrum when faced with a broad differential diagnosis. This patient was diagnosed with drug-resistant tuberculosis of the skin, and we felt that his neurologic syndrome was consistent with drug-resistant tuberculosis of the brain, unmasked by immunologic recovery in the setting of recent initiation of antiretroviral treatment. We argue that aggressive and timely empiric multidrug-resistant tuberculosis treatment is important in cases where drug-resistant tuberculosis is suspected. Knowledge gaps include a limited understanding of immune reconstitution and the optimal timing of antiretroviral treatment in the setting of drug-resistant tuberculosis.

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Tuberculous meningitis in HIV-infected patients: drug susceptibility and clinical outcome

Cited by 43 publications

References 8 publications

Tuberculous meningitis in patients infected with human immunodeficiency virus

Tuberculous meningitis in patients infected with human immunodeficiency virus

Tuberculous Meningitis in Patients Living with HIV

Challenges of Diagnosis and Management of Tuberculosis and HIV Coinfection in Resource-Limited Settings: A Case Report from Lima, Peru

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