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Abstract
Tuberculous meningitis in patients with human immunodeficiency virus infection in Argentina
Cecchini D.1, Ambrosioni Czyrko J.1, Brezzo C.1, Corti M.1, Perez M.1, Ambroggi M.1
1Hospital Muñiz, Buenos Aires, Argentina
Objective: To evaluate the clinical features, cerebrospinal fluid (CSF) characteristics and drug resistance patterns in HIV-infected patients with tuberculous meningitis (TM).
Methods: We retrospectively analyzed clinical and laboratory findings of 101 HIV-infected patients with isolation of Mycobacterium tuberculosis from CSF attended at the Muñiz Hospital, Buenos Aires city, Argentina (1996-2004). Data were processed with Statistix software (Chi-square test).
Results: male sex: 68%; mean age: 32 years (17-56 years); 53% had previous history of pulmonary or extrapulmonary tuberculosis. Thirty two percent had previous AIDS indicator condition. Mycobacterium tuberculosis was isolated from other site (sputum, blood culture) in 55% of the patients. Forty one percent of the CSF isolates were resistant, at least, to isoniazid and rifampin (multirresistant tuberculosis, MR-TB). Four CSF samples (4%) were positive for acid fast bacilli at direct microscopic observation. CSF findings were: pleocytosis: 80% (median 47cell/ml, range 1-3150), 87% with mononuclear predominance; elevated protein level: 66% (median 0.77g/l, range 0.10-10); glucose level <30mg/dl: 52% (average 31, range 0-112). Eleven percent of the patients had no CSF alterations. Lumbar puncture was performed in stage II of the TM in 73% of the patients; 13% had simultaneous diagnosis of another AIDS indicator condition. The median CD4 T-cell count was 53 cell/ul (range: 0-310). Most frequent finding in imaging studies was hydrocephaly (26% of the patients); central nervous system images were normal in 22%. Global mortality was 62.5%. Mortality rate was significantly higher in the MR-TB group (79%) in comparison with the non MR-TB group (51%) [Odds Ratio: 3.54 CI 95%: 1.44-8.68; p<0.01].
Conclusions: Meningeal involvement due to MR-TB was very frequent in our study, with a higher mortality rate. An important percentage of patients had normal CSF protein levels (34%) and cell counts (20%), what could be related to the very low CD4 T-cell count found in our population.
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