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[Tuberculous meningitis: clinical, biological and x-ray computed tomographic comparison between patients with or
1Service de Maladies infectieuses et tropicales Hôpital Pitié-Salpêtrière, Paris.
Objectives:
Determine possible differences in clinical manifestations, laboratory findings and neuroimaging results in tuberculous meningitis patients with and without HIV infection.
Patients And Methods:
We retrospectively reviewed data of 38 patients with positive cerebrospinal fluid cultures for Mycobacterium tuberculosis who were hospitalized in 3 university hospitals in Paris over the last 11 years.
Results:
There were 24 HIV-infected patients and 14 without HIV infection. Mean CD4 lymphocyte count was 103 +/- 180/mm3 in the HIV group. Age (median age = 33 years for the HIV group vs. 53 for the non-HIV group), sex ratio (3 vs. 0.75), and prior history of tuberculosis (46% vs. 43%) were similar in both groups. Clinical presentation was similar for headache (83% in HIV group vs. 50% in non-HIV group; p = 0.02) and confusion (54% vs. 93% in non-HIV group p = 0.05). Serum natremia (mmol/l) (131 +/- 5 vs. 125 +/- 8; p = 0.024), white blood cell count (x 10(9)/l) (5.8 +/- 4.7 vs. 10.7 +/- 1.7; p = 0.37) and erythrocyte sedementation rate (mm/h) (68 +/- 34 vs. 31 +/- 35; p = 0.003) were significantly different in the 2 groups. Median cerebrospinal fluid findings were similar in the 2 groups: leukocytes (x 10(6)/l) (375 +/- 860 vs 218 +/- 250), glucose (mmol/l) (2.3 +/- 0.9 vs 2.7 +/- 1.9) and protein (g/l) (3.8 +/- 7.1 vs. 2.6 +/- 1.6). CT-scans of the brain were similar in the 2 groups. Mortality during hospitalization was similar (42% vs 36%; NS).
Conclusion:
HIV infection appears to have little impact on the presentation of tuberculous meningitis.
Insights
Tuberculous meningitis presentation is similar in patients with and without HIV infection, despite differences in serum sodium and erythrocyte sedimentation rate. HIV status has minimal impact on the clinical and neuroimaging findings of this serious infection.
Area of Science:
- Infectious Diseases
- Neurology
- Public Health
Background:
- Tuberculous meningitis (TBM) is a severe form of extrapulmonary tuberculosis affecting the central nervous system.
- Human Immunodeficiency Virus (HIV) infection is a significant risk factor for tuberculosis and can alter its clinical presentation.
- Understanding how HIV co-infection impacts TBM is crucial for diagnosis and management.
Purpose of the Study:
- To compare clinical manifestations, laboratory findings, and neuroimaging results in patients with TBM, stratified by HIV status.
- To identify any specific differences that might aid in the early diagnosis or treatment of TBM in HIV-infected individuals.
Main Methods:
- A retrospective review of 38 patients with confirmed TBM (positive cerebrospinal fluid cultures for Mycobacterium tuberculosis) was conducted.
- Data from patients hospitalized in three Paris university hospitals over 11 years were analyzed.
- Patients were divided into two groups: those with HIV infection (n=24) and those without (n=14).
Main Results:
- While age and prior tuberculosis history were similar, HIV-infected patients presented more frequently with headache (83% vs. 50%) and less with confusion (54% vs. 93%).
- Significant differences were observed in serum natremia and erythrocyte sedimentation rate between the groups.
- Cerebrospinal fluid analysis, brain CT scans, and in-hospital mortality rates were comparable between HIV-infected and non-HIV-infected patients.
Conclusions:
- HIV infection appears to have a limited effect on the overall clinical presentation and diagnostic findings of tuberculous meningitis.
- Despite some variations in specific symptoms and lab markers, the core features and outcomes of TBM are not substantially altered by HIV status in this cohort.