The clinical, radiological and pathological profile of tuberculous meningitis in patients with and without human immunodeficiency virus infection

Katrak, Sarosh M.; Shembalkar, Prafulla K.; Bijwe, Sanjay; Bhandarkar, L D

doi:10.1016/s0022-510x(00)00440-8

Cited by 153 publications

(146 citation statements)

References 18 publications

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“…HIV-positive individuals with TBM generally have a poor prognosis (1,26), although the neurological features of the disease at presentation are probably not influenced by HIV infection (27). However, this study suggests HIV infection alters the intracerebral inflammatory response.…”

Section: Discussionmentioning

confidence: 66%

Pretreatment Intracerebral and Peripheral Blood Immune Responses in Vietnamese Adults with Tuberculous Meningitis: Diagnostic Value and Relationship to Disease Severity and Outcome

Simmons

Thwaites

Quyen

et al. 2006

The Journal of Immunology

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Tuberculous meningitis (TBM) is the most devastating form of tuberculosis. Both intracerebral and peripheral blood immune responses may be relevant to pathogenesis, diagnosis, and outcome. In this study, the relationship between pretreatment host response, disease phenotype, and outcome in Vietnamese adults with TBM was examined. Before treatment, peripheral blood IFN-γ ELISPOT responses to the Mycobacterium tuberculosis Ags ESAT-6, CFP-10, and purified protein derivative (PPD) were a poor diagnostic predictor of TBM. Cerebrospinal fluid IL-6 concentrations at presentation were independently associated with severe disease presentation, suggesting an immunological correlate of neurological damage before treatment. Surprisingly however, elevated cerebrospinal fluid inflammatory cytokines were not associated with death or disability in HIV-negative TBM patients at presentation. HIV coinfection attenuated multiple cerebrospinal fluid inflammatory indices. Low cerebrospinal fluid IFN-γ concentrations were independently associated with death in HIV-positive TBM patients, implying that IFN-γ contributes to immunity and survival. Collectively, these results reveal the effect of HIV coinfection on the pathogenesis of TBM and suggest that intracerebral immune responses, at least in HIV-negative cases, may not be as intimately associated with disease outcome as previously thought.

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Section: Discussionmentioning

confidence: 66%

Pretreatment Intracerebral and Peripheral Blood Immune Responses in Vietnamese Adults with Tuberculous Meningitis: Diagnostic Value and Relationship to Disease Severity and Outcome

Simmons

Thwaites

Quyen

et al. 2006

The Journal of Immunology

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“…By comparison, more recent studies report mortality rates ranging from 40 to 70% (137,188,298). A correlation of higher mortality with HIV-1 coinfection is sometimes present (190,383).…”

Section: Mycobacterium Tuberculosismentioning

confidence: 91%

“…Nevertheless, patients with normal CSF or CSF that shows a neutrophil predominance are occasionally found; most of these individuals have impaired host defenses (188,214). Interestingly, most series comparing tuberculous meningitis in patients with and without HIV-1 infection do not find striking differences between the two groups of patients in the clinical features of the disease or in the CSF analysis (32,188,190,346,383). In contrast, HIV-1-coinfected individuals do show more frequent abnormalities such as space-occupying lesions or hydrocephalus on brain-imaging studies.…”

Section: Mycobacterium Tuberculosismentioning

confidence: 99%

Invasion of the Central Nervous System by Intracellular Bacteria

2004

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Infection of the central nervous system (CNS) is a severe and frequently fatal event during the course of many diseases caused by microbes with predominantly intracellular life cycles. Examples of these include the facultative intracellular bacteria Listeria monocytogenes, Mycobacterium tuberculosis, and Brucella and Salmonella spp. and obligate intracellular microbes of the Rickettsiaceae family and Tropheryma whipplei. Unfortunately, the mechanisms used by intracellular bacterial pathogens to enter the CNS are less well known than those used by bacterial pathogens with an extracellular life cycle. The goal of this review is to elaborate on the means by which intracellular bacterial pathogens establish infection within the CNS. This review encompasses the clinical and pathological findings that pertain to the CNS infection in humans and includes experimental data from animal models that illuminate how these microbes enter the CNS. Recent experimental data showing that L. monocytogenes can invade the CNS by more than one mechanism make it a useful model for discussing the various routes for neuroinvasion used by intracellular bacterial pathogens

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“…Findings on brain MRI may further support a diagnosis of TB meningitis and include the presence of basal exudates, basilar meningeal enhancement, and hydrocephalus. 9,16 As in this case, these findings may not be noted on initial presentation and require repeated imaging.…”

Section: 11mentioning

confidence: 74%

“…In immunocompetent patients with TB meningitis, CSF analysis often shows an increased opening pressure (>250 mmH 2 O), high white cell count (100-500 x10 6 cells/L) with a lymphocytic predominance (rarely polymorphonuclear leukocytes predominate early), high protein levels, and decreased CSF:blood glucose ratio. 2,5,9 However, these findings are not exclusive to TB meningitis and may be seen in subacute meningitis syndromes due to viruses, cryptococcosis, syphilis, Borrelia burgdorferi, or malignancy. 6 HIV co-infected patients may have atypical findings such as normal cell count and glucose.…”

Section: Discussionmentioning

confidence: 99%

A case of tuberculous meningitis

McFadgen

Bonnar

Davis

2016

DMJ

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In Canada, meningitis is a rare manifestation of Mycobacterium tuberculosis infection. Additionally, a microbiological diagnosis can be difficult because of low sensitivity of mycobacterial tests of cerebrospinal fluid specimens. The typical presentation of meningitis is in the form of subacute meningitis, which is life threatening in the absence of appropriate treatment. Therefore, a high index of suspicion must be maintained. We report a case of tuberculous meningitis highlighting the presentation, workup, and treatment of this serious infection. This report highlights the challenges in identifying cases and establishing a timely diagnosis. Close monitoring of the patient and collecting multiple cerebrospinal fluid samples can improve sensitivity.

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The clinical, radiological and pathological profile of tuberculous meningitis in patients with and without human immunodeficiency virus infection

Cited by 153 publications

References 18 publications

Pretreatment Intracerebral and Peripheral Blood Immune Responses in Vietnamese Adults with Tuberculous Meningitis: Diagnostic Value and Relationship to Disease Severity and Outcome

Pretreatment Intracerebral and Peripheral Blood Immune Responses in Vietnamese Adults with Tuberculous Meningitis: Diagnostic Value and Relationship to Disease Severity and Outcome

Invasion of the Central Nervous System by Intracellular Bacteria

A case of tuberculous meningitis

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