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Tuberculous meningitis with acellular cerebrospinal fluid in AIDS patients
F Laguna1, M Adrados, A Ortega
1Centro Nacional de Investigacion, Instituto de Salud Carlos III, Madrid, Spain.
Objective:
To describe the clinical manifestations of tuberculous meningitis in HIV-positive patients with acellular cerebrospinal fluid (CSF).
Design:
Retrospective analysis of case reports.
Methods:
Four HIV-positive patients with acellular CSF and tuberculous meningitis are reported.
Results:
Clinical presentation did not indicate meningeal infection in three of the four cases, and CSF tests were unusual in all cases. Two patients were diagnosed only after death.
Conclusions:
Acellular CSF may obstruct the diagnosis of tuberculous meningitis in AIDS patients.
Insights
Tuberculous meningitis in HIV-positive patients can be difficult to diagnose when cerebrospinal fluid (CSF) is acellular. This presentation may delay diagnosis, even in acquired immunodeficiency syndrome (AIDS) patients.
Area of Science:
- Neurology
- Infectious Diseases
- Immunology
Background:
- Tuberculous meningitis (TBM) is a severe form of tuberculosis affecting the central nervous system.
- Human immunodeficiency virus (HIV) infection complicates TBM diagnosis and management.
- Acellular cerebrospinal fluid (CSF) is an atypical finding in infectious meningitis.
Observation:
- This study reports on four HIV-positive patients diagnosed with tuberculous meningitis despite having acellular CSF.
- Clinical manifestations were non-specific, failing to suggest meningeal involvement in most cases.
- Cerebrospinal fluid analysis revealed unusual findings in all reported patients.
Findings:
- Tuberculous meningitis in HIV-positive individuals can present with acellular CSF, masking typical signs of infection.
- Diagnostic delays occurred in three out of four cases due to atypical clinical and CSF findings.
- Two patients were diagnosed posthumously, highlighting challenges in early detection.
Implications:
- Acellular CSF should not rule out tuberculous meningitis in immunocompromised patients, particularly those with HIV/AIDS.
- Clinicians must maintain a high index of suspicion for TBM in HIV-positive individuals with unexplained neurological symptoms, even with normal CSF cell counts.
- Further research is needed to elucidate the mechanisms behind acellular CSF in TBM and develop improved diagnostic strategies.