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Sequencing of Bacterial Microflora in Peripheral Blood: our Experience with HIV-infected Patients
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[Persistent neutrophilic meningitis in a patient with the acquired immunodeficiency syndrome]

S F Marinho1, V H Paciullo, M O Fonseca

  • 1Instituto de Infectologia Emilio Ribas, São Paulo, Brasil.

Revista Da Sociedade Brasileira De Medicina Tropical
|May 1, 1997
PubMed

Insights

Persistent neutrophilic meningitis in an HIV-positive patient was linked to drug-resistant Mycobacterium tuberculosis. This rare condition highlights challenges in diagnosing and treating complex central nervous system infections.

Area of Science:

  • Infectious Diseases
  • Neurology
  • Immunology

Background:

  • Persistent neutrophilic meningitis is a rare clinical presentation characterized by a neutrophil predominance in cerebrospinal fluid (CSF) after seven days of treatment.
  • The case involves an HIV-positive patient presenting with prolonged fever and mental disorder, exhibiting neutrophilic pleocytosis in CSF for over five months.

Observation:

  • The patient received antituberculous drugs and corticosteroids, with initial negative serology, smears, and cultures for three months.
  • On day 60, CSF analysis revealed acid-fast bacilli, and culture confirmed Mycobacterium tuberculosis resistant to isoniazid.

Findings:

  • The study identifies Mycobacterium tuberculosis resistant to isoniazid as the cause of persistent neutrophilic meningitis in this immunocompromised patient.
  • Factors contributing to this uncommon presentation include disturbed cell-mediated immunity (IL-8, TNF release), potential drug interactions altering CSF drug concentrations, and the rise of multidrug-resistant strains.

Implications:

  • This case underscores the importance of considering drug-resistant tuberculosis in persistent meningitis, especially in HIV-positive individuals.
  • It highlights the need for careful monitoring and reassessment of treatment in complex CNS infections.
  • Understanding immune dysregulation and drug interactions is crucial for managing such challenging cases.

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