中枢神经系统结核病在免疫受损患者:一个病例报告强调免疫状态和早期识别和治疗
Marta Quaresma1, Madalena Paulino2, Ana Oliveira1
1Internal Medicine Department, Hospital Vila Franca Xira, Vila Franca Xira, PRT.
Cureus
|January 23, 2024
概括
这一案例突出了艾滋病毒阳性患者肺结核髓炎的罕见病例. 早期诊断和治疗中枢神经系统结核病 (CNS TB) 对于改善免疫受损个体的结果至关重要.
科学领域:
- 神经学 神经学
- 传染性疾病 传染性疾病
- 免疫学 免疫学 免疫学
背景情况:
- 结核病 (TB) 是一个全球性的健康问题,肺外结核病,特别是中枢神经系统 (CNS) 的结核病,在免疫功能低下的个体,特别是艾滋病毒感染者中构成重大挑战.
- 中枢神经系统结核病可以表现为结核性脑膜炎 (TBM),结核瘤或,而TBM是最常见的,与高发病率和死亡率有关.
- 结核性脑膜炎是一种罕见的TBM并发症,涉及脊髓,预后特别差.
研究的目的:
- 在接受ART的HIV-1阳性患者中呈现结核性脑膜炎 (TBM) 病例与并发性脑膜炎.
- 强调早期临床怀疑和中枢神经系统结核病在免疫受损患者的及时诊断工作的重要性.
- 讨论共感染个体中中枢神经系统结核病的诊断挑战和治疗考虑.
主要方法:
- 一个61岁的HIV-1感染男性的临床病例报告,表现为意识变化,发烧和神经缺陷.
- 诊断评估包括脑脊液 (CSF) 分析 (生物化学,细胞计数, * Mycobacterium tuberculosis * 的PCR),干扰素马释放试验 (IGRA),部CT和脊柱MRI.
- 治疗包括抗结核药物和甲,临床和放射监测.
主要成果:
- 脑脊髓液分析显示了TBM的特征性发现:黄染,高蛋白尿,低血糖和单核细胞瘤.
- 头骨和脊柱MRI证实了脑膜增强和骨髓炎,尽管最初的头骨CT阴性.
- 患者在治疗开始后出现了最初的神经改善,尽管运动缺陷显示恢复延迟. 在8周后,对*Mycobacterium tuberculosis*的CSF培养是负面的.
结论:
- 早期识别微妙的临床症状和及时启动治疗对于改善中枢神经系统结核病的预后至关重要,特别是在HIV阳性患者中.
- 像MRI这样的先进成像对于诊断中枢神经系统结核病和相关并发症,如脑膜炎至关重要,即使初始CT是不显著的.
- 在HIV同时感染的患者中,中枢神经系统结核病的管理需要仔细考虑免疫状态 (CD4+计数,病毒载量) 和ART状态.
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