Comparison of Diagnostic Criteria of Tuberculous Meningitis in Human Immunodeficiency Virus-Infected and Uninfected Children

Weert, Esther M. Van Der; Hartgers, Nienke M.; Schaaf, H. Simon; Eley, Brian; Pitcher, R; Wieselthaler, Nicky; Laubscher, Ria; Donald, Peter R.; Schoeman, Johan

doi:10.1097/01.inf.0000183751.75880.f8

Cited by 66 publications

(46 citation statements)

References 16 publications

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“…The values of routinely measured cerebrospinal fluid parameters are almost similar in HIV-positive and negative patients with tuberculous meningitis [26,31,35]. Some studies, however, noted a lower cerebrospinal fluid leukocyte count and a lower protein level in HIV-positive patients [25,33].…”

Section: Cerebrospinal Fluid Findingsmentioning

confidence: 92%

“…The classical clinical manifestations of tuberculous meningitis such as fever, headache, vomiting, and weight loss occurred in equal frequency in patients with and without HIV infection [30]. Even in a pediatric study, both HIV-infected patients and HIV-uninfected patients with tuberculous meningitis had almost similar clinical manifestations [31]. A Vietnamese study observed, in a comparison to patients with HIV-negative tuberculous meningitis, that HIV-infected patients with tuberculous meningitis were younger in age and were more commonly male.…”

Section: Clinical Features-impact Of Hiv Infectionmentioning

confidence: 94%

“…The influence of HIV infection on intracranial imaging of tuberculous meningitis has been extensively investigated, and the findings suggested that basal meningeal enhancement and hydrocephalus on computed tomography of the brain were less common in HIV-infected patients [25,31]. HIV-infected individuals were also more likely to present with cerebral infarcts and mass lesions [35].…”

Section: Neuroimagingmentioning

confidence: 97%

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Tuberculous meningitis in patients infected with human immunodeficiency virus

Garg

Sinha

2010

J Neurol

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Tuberculosis is the most common opportunistic infection in human immunodeficiency virus (HIV) infected persons. HIV-infected patients have a high incidence of tuberculous meningitis as well. The exact incidence and prevalence of tuberculous meningitis in HIV-infected patients are not known. HIV infection does not significantly alter the clinical manifestations, laboratory, radiographic findings, or the response to therapy. Still, some differences have been noted. For example, the histopathological examination of exudates in HIV-infected patients shows fewer lymphocytes, epithelioid cells, and Langhan's type of giant cells. Larger numbers of acid-fast bacilli may be seen in the cerebral parenchyma and meninges. The chest radiograph is abnormal in up to 46% of patients with tuberculous meningitis. Tuberculous meningitis is likely to present with cerebral infarcts and mass lesions. Cryptococcal meningitis is important in differential diagnosis. The recommended duration of treatment in HIV-infected patients is 9-12 months. The benefit of adjunctive corticosteroids is uncertain. Antiretroviral therapy and antituberculosis treatment should be initiated at the same time, regardless of CD4 cell counts. Tuberculous meningitis may be a manifestation of paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome. Some studies have demonstrated a significant impact of HIV co-infection on mortality from tuberculous meningitis. HIV-infected patients with multidrug-resistant tuberculous meningitis have significantly higher mortality. The best way to prevent HIV-associated tuberculous meningitis is to diagnose and isolate infectious cases of tuberculosis promptly and administer appropriate treatment.

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Section: Cerebrospinal Fluid Findingsmentioning

confidence: 92%

Section: Clinical Features-impact Of Hiv Infectionmentioning

confidence: 94%

Section: Neuroimagingmentioning

confidence: 97%

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Tuberculous meningitis in patients infected with human immunodeficiency virus

Garg

Sinha

2010

J Neurol

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“…However, studies from SA report extremely low diagnostic yields by this method. [5] Culture of M. tuberculosis from CSF is similarly an insensitive diagnostic test and as time to positivity is at least 2 weeks, it is too slow to be clinically relevant in guiding treatment initiation in TBM. [3] Measures shown to improve the sensitivity of these microbiological tests, which can easily be implemented in our setting, include analysing large volumes of CSF (≥6 mL is advised), and performing repeated LPs.…”

Section: Definitive Diagnostic Methodsmentioning

confidence: 99%

The diagnosis and medical management of tuberculous meningitis in adults

Marais

Wilkinson

2014

S Afr Med J

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“…HIV-infected patients may have altered clinical presentations, such as in pathological features, CSF parameters, frequency of infection with MDR-TB and mortality. Hospital-associated mortality was significantly higher in HIV-infected patients (Cecchini et al, 2009;van der Weert et al, 2006;Katrak et al, 2000;Bandyopadhyay et al, 2009). Other studies have found that HIV infection was not associated with mortality rate or altered neurological presentation in TBM, though additional extrapulmonary TB was more likely to occur in HIV-infected patients and may have also affected the survival rate (Faksri et al, 2011a;Thwaites et al, 2005a).…”

Section: Predisposing Risk Factorsmentioning

confidence: 99%