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Multidrug-resistant tuberculous meningitis in patients with AIDS
G L Daikos1, T Cleary, A Rodriguez
1Department of Medicine, University of Miami School of Medicine, Miami, Florida, USA. gdaikos@med.uoa.gr
Abstract:
We present clinical manifestations, bacteriologic characteristics, and outcomes for eight patients with multidrug-resistant (MDR) tuberculous meningitis and AIDS. All developed meningitis as a terminal complication of previously diagnosed MDR-TB despite anti-tuberculosis therapy. Seven patients presented with fever, five with headache, four with altered mentation, two with focal deficits and one with seizures. CSF examination revealed pleocytosis, hypoglychorrhachia and elevated protein. Mycobacterium tuberculosis resistant to at least isoniazid and rifampin was isolated from all patients. Intracerebral mass lesions were detected in three patients, hydrocephalus in three, meningeal enhancement in five, and infarcts in two. Seven patients died 1-16 weeks after the diagnosis of meningitis; the eighth was lost to follow-up. MDR tuberculous meningitis is a difficult-to-treat infection with a high fatality rate.
Insights
Multidrug-resistant tuberculous meningitis (MDR-TB) is a severe complication in AIDS patients, often proving fatal despite treatment. This study highlights the poor outcomes and clinical challenges associated with this difficult-to-treat infection.
Area of Science:
- Infectious Diseases
- Neurology
- Public Health
Background:
- Tuberculous meningitis (TB meningitis) remains a significant global health challenge, particularly in individuals with compromised immune systems.
- Multidrug-resistant tuberculosis (MDR-TB) presents a growing therapeutic challenge, with tuberculous meningitis being a severe and often fatal complication.
- Acquired immunodeficiency syndrome (AIDS) further complicates TB meningitis management due to immune suppression.
Purpose of the Study:
- To describe the clinical features, microbiological profiles, and patient outcomes for a cohort of patients with multidrug-resistant tuberculous meningitis (MDR-TB) and AIDS.
- To identify key challenges in the diagnosis and management of MDR-TB meningitis in the context of advanced HIV infection.
Main Methods:
- Retrospective case series analysis of eight patients diagnosed with MDR-TB meningitis and AIDS.
- Review of clinical presentations, cerebrospinal fluid (CSF) findings, neuroimaging results, and treatment outcomes.
- Bacteriologic characterization of Mycobacterium tuberculosis isolates to confirm drug resistance patterns.
Main Results:
- All eight patients presented with meningitis as a terminal complication of known MDR-TB, despite ongoing anti-tuberculosis therapy.
- Common clinical manifestations included fever, headache, and altered mentation. CSF analysis consistently showed pleocytosis, low glucose, and high protein levels.
- Neuroimaging revealed intracerebral mass lesions, hydrocephalus, meningeal enhancement, and infarcts in several patients. Seven patients died within 16 weeks of meningitis diagnosis; one was lost to follow-up.
Conclusions:
- MDR-TB meningitis in patients with AIDS is associated with a very high fatality rate and represents a difficult-to-treat infectious complication.
- Early diagnosis and effective, though challenging, therapeutic strategies are crucial for managing this severe condition.
- The study underscores the need for improved diagnostic and treatment approaches for MDR-TB meningitis in immunocompromised populations.