Central nervous system tuberculosis with the acquired immunodeficiency syndrome and its related complex

Area of Science:

• Neurology
• Infectious Diseases
• Public Health

Background:

• Central nervous system (CNS) tuberculosis is a severe manifestation of Mycobacterium tuberculosis infection.
• Acquired immunodeficiency syndrome (AIDS) and AIDS-related complex (ARC) are significant risk factors for disseminated tuberculosis, including CNS involvement.
• Intravenous drug abusers represent a high-risk population for both HIV and tuberculosis.

Observation:

• A study evaluated 10 patients (3 with AIDS, 7 with ARC) over 48 months with CNS tuberculosis.
• The majority of patients were intravenous drug abusers (9/10) and one was of Haitian origin.
• Clinical presentations included meningitis, multiple cerebral abscesses, and tuberculomas, often presenting as ring-enhancing or hypodense brain lesions.

Findings:

• All Mycobacterium tuberculosis isolates were susceptible to standard antitubercular drugs.
• Patients received multi-drug regimens including isoniazid, rifampin, and pyrazinamide, with some receiving streptomycin.
• Outcomes varied: 3 patients with AIDS died from opportunistic infections secondary to CNS tuberculosis, while 3 patients with ARC improved, 3 were lost to follow-up, and 1 died.

Implications:

• CNS tuberculosis should be strongly considered in the differential diagnosis of brain mass lesions in intravenous drug abusers with AIDS or ARC.
• Biopsy of accessible CNS mass lesions is recommended due to the curable nature of tuberculosis.
• Preventive therapy for tuberculosis may be warranted in at-risk drug abusers without active disease.