3rd International AIDS Society Conference on HIV Pathogenesis and Treatment Rio de Janeiro - July 24 - 27, 2005

TUBERCULOUS MENINGITIS IN PATIENTS WITH HUMAN IMMUNODEFICIENCY VIRUS INFECTION IN ARGENTINA

IAS Conf HIV Pathog Treat 2005 Jul 24-27;3rd: Abstract No. WePp0301

Cecchini D., Ambrosioni Czyrko J., Brezzo C., Corti M., Perez M., Ambroggi M.
Hospital 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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050724
Clinical | WePp0301 | Diego Cecchini
Tuberculosis

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