Tuberculous Meningitis in Patients Infected with the Human Immunodeficiency Virus

Berenguer, Juan; Moreno, Santiago; Laguna, Fernando Ballester; Vicente, Teresa; Adrados, Magdalena; Ortega, A; González-Lahoz, Juan; Bouza, Emilio

doi:10.1056/nejm199203053261004

Cited by 393 publications

(207 citation statements)

References 11 publications

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“…HIV-infected patients with TB are at increased risk for meningitis, but infection with HIV does not appear to change the clinical manifestations or the outcome of TB meningitis. 50 …”

Section: Central Nervous System -Tuberculous Meningitismentioning

confidence: 99%

A systematic review of rapid diagnostic tests for the detection of tuberculosis infection

Dinnes¹,

Deeks²,

Kunst³

et al. 2007

Health Technol Assess

530

361

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Non-UK purchasers will have to pay a small fee for post and packing. For European countries the cost is £2 per monograph and for the rest of the world £3 per monograph.You can order HTA monographs from our Despatch Agents:-fax (with credit card or official purchase order) -post (with credit card or official purchase order or cheque) -phone during office hours (credit card only).Additionally the HTA website allows you either to pay securely by credit card or to print out your order and then post or fax it. NHS libraries can subscribe free of charge. Public libraries can subscribe at a very reduced cost of £100 for each volume (normally comprising 30-40 titles). The commercial subscription rate is £300 per volume. Please see our website for details. Subscriptions can only be purchased for the current or forthcoming volume. Contact details are as follows: Payment methods Paying by chequeIf you pay by cheque, the cheque must be in pounds sterling, made payable to Direct Mail Works Ltd and drawn on a bank with a UK address. Paying by credit cardThe following cards are accepted by phone, fax, post or via the website ordering pages: Delta, Eurocard, Mastercard, Solo, Switch and Visa. We advise against sending credit card details in a plain email. Paying by official purchase orderYou can post or fax these, but they must be from public bodies (i.e. NHS or universities) within the UK. We cannot at present accept purchase orders from commercial companies or from outside the UK. How do I get a copy of HTA on CD?Please use the form on the HTA website (www.hta.ac.uk/htacd.htm). Or contact Direct Mail Works (see contact details above) by email, post, fax or phone. HTA on CD is currently free of charge worldwide.The website also provides information about the HTA Programme and lists the membership of the various committees. HTA NIHR Health Technology Assessment ProgrammeT he Health Technology Assessment (HTA) programme, now part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the costs, effectiveness and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined to include all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care, rather than settings of care. The research findings from the HTA Programme directly influence decision-making bodies such as the National Institute for Health and Clinical Excellence (NICE) and the National Screening Committee (NSC). HTA findings also help to improve the quality of clinical practice in the NHS indirectly in that they form a key component of the 'National Knowledge Service'. The HTA Programme is needs-led in that it fills gaps in the evidence needed by the NHS. There are three routes to the start of projects. First is the commissioned route. Suggestions for research are actively sought from people working in the NHS, the public and consumer groups and professional bodies such as ...

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“…HIV-infected patients with TB are at increased risk for meningitis, but infection with HIV does not appear to change the clinical manifestations or the outcome of TB meningitis. 50 …”

Section: Central Nervous System -Tuberculous Meningitismentioning

confidence: 99%

A systematic review of rapid diagnostic tests for the detection of tuberculosis infection

Dinnes¹,

Deeks²,

Kunst³

et al. 2007

Health Technol Assess

530

361

View full text Add to dashboard Cite

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“…3 A normal CSF examination was reported in a previous study. 6 This case strongly emphasizes that the diagnosis of opportunistic tuberculosis in the setting of HIV infection can be elusive. Immune reconstruction inflammatory syndrome is an unlikely cause of her neurological symptoms, as she developed these symptoms before HAART.…”

Section: Discussionmentioning

confidence: 91%

Acute paraplegia in a patient with AIDS and a normal CSF examination

Lunn

Clarke

Aldeen

2008

Journal of Hospital Medicine

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We report a case of tuberculous myeloradiculitis in a patient with AIDS. The case highlights the difficulty in reaching a diagnosis for the neurological symptoms of a patient with a normal CSF examination and the need for HIV screening of KEYWORDS: tuberculosis, HIV, myeloradiculitis.A 35-year-old Zimbabwean woman living in London, England, presented to the local accident and emergency department with a history of cough, shortness of breath, nausea, vomiting, diarrhea, and weight loss of 3 months' duration. Her chest X-ray showed miliary shadowing. She was admitted to the hospital and commenced on antituberculous medications and offered an HIV test. Two weeks later, her sputum grew acid-fast bacilli (AFB) and her HIV-1 test came back positive. Her baseline T-lymphocyte CD4 cell count was 6 cells/mm 3 (reference range 455-1320), and her HIV-1 RNA viral load (VL) was 4,760,000 copies/mL. However, because of her multiple symptoms, her antiretroviral therapy was postponed. Four weeks later the patient's general condition improved, but she started to experience pain in her right thigh, followed by progressive right leg weakness without sensory loss. This new change affected her mobility, and she fell while walking. Within a week the patient developed progressive flaccid paraparesis with radicular sensory disturbance. This was followed by acute onset of flaccid paraplegia, extensor plantars, sensory loss to T10, and urinary incontinence. Her cerebrospinal fluid (CSF) examination revealed normal protein, glucose, and white cell count and no AFB or malignant cells, A second CSF after 3 weeks was abnormal, with protein of 0.79 g/L, normal glucose, 7 white cells (no malignant cells), and positive oligoclonal bands. The CSF screening for AFB-PCR, treponemes, toxoplasma, cryptococcal antigen Epstein-Barr virus, cytomegalovirus (CMV), herpes simplex virus, human T-lymphotropic virus, and JC virus was negative. Neurophysiological studies confirmed the presence of severe multilevel radiculopathy. The MRI scan of her head and spine showed multiple intraparenchymal cerebral tuberculomata and cavitation at T 9-11 that enhanced postgadolinium (see Fig. 1). She was commenced on highly active antiretroviral therapy (HAART) and steroids. Ten weeks later her HIV-1 RNA VL became undetectable in the ultrasensitive assay (cutoff 50 copies/mL), and she regained sensation in both legs and was able to stand with support. Posttreatment MRI appearances demonstrated

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“…It might be considered adventitious that Burn isolated a germ (9) with an eerie resemblance to Jackson and Livingston's (10, 11) mycobacteria/nocardia cross in three Von Economo's infants at autopsy; or that Jackson found acidfast forms in Burn's bacillus that she implicated as causing Wilson's disease (11), dominant cause of Parkinson's in the young. It might be considered insignificant that tuberculosis-like Nocardia has a specific affinity for substantia nigral neurons (1) (23). It could be considered coincidental that Guam, where T.B.…”

Section: Resultsmentioning

confidence: 99%

“…And Duvoisin all but ruled out any of the suspected viruses implicated at the time (22). Even in AIDS, often associated with Parkinson's, mycobacteria such as tuberculosis have been reported as the most common central nervous pathogen in HIV-infected people (23). Many of the patients with both Parkinson's and T.B.…”

Section: Historical and Other Parallelsmentioning

confidence: 99%

Parkinson's: another look

Broxmeyer

2002

Medical Hypotheses

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Tuberculous Meningitis in Patients Infected with the Human Immunodeficiency Virus

Abstract: HIV-infected patients with tuberculosis are at increased risk for meningitis, but infection with HIV does not appear to change the clinical manifestations or the outcome of tuberculous meningitis.

Cited by 393 publications

References 11 publications

A systematic review of rapid diagnostic tests for the detection of tuberculosis infection

A systematic review of rapid diagnostic tests for the detection of tuberculosis infection

Acute paraplegia in a patient with AIDS and a normal CSF examination

Parkinson's: another look

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