Abstract
Background & Aim: HIV infected persons are at risk of developing disseminated forms of TB, such as tuberculous meningitis (TBM). As the HIV infection primarily impairs the cell mediated immunity (CMI), the immune responses to TB bacilli seen in HIC infected may be different and may manifest in different clinical, radiological and CSF findings. Moreover as the immunity varies with CD4 count, there could be differences in clinico-radiological features at different CD4 counts. The present study was conducted to assess the clinical, CSF and radiological features of TBM in HIV positives and to study its relation with CD4 count.
Materials and Methods: Clinical, radiological and CSF features of 100 HIV positive TBM patients were studied and its relation with CD4 count was analyzed.
Results: The findings are notable by the difference in radiological findings between different CD4 count groups. Basal meningeal enhancement and hydrocephalus was conspicuously less common in those with CD4 count less than 50. Radiological findings are also remarkable by the presence of normal radiological findings in a sizeable proportion of patients with low CD4 count. CSF protein and total cell count is significantly less in those with CD4 count less than 50.
Conclusion: Like tuberculosis of other organs (notably lung), clinical, CSF and radiological findings in HIV patients can be quite different especially in those with severe immunosuppression. Therefore, a high degree of suspicion is required when interpreting radiological and CSF findings of HIV positive TBM patients.
Keywords: HIV, TBM, CD4 Count.
References
- Global tuberculosis report 2017. World Health Organization, Geneva; 2017. Available from: http//www.who.int/tb/publications/ global_report/exec_Summary_13 Nov 2017.pdf/ua=1.
- AIDS Control and Prevention (AIDSCAP) Project of Family Health Internal, The Francois-Xavier Bagnoud Center for Public Health and Human Rights of the Harvard School of Public Health UNAIDS. The Status and Trends of the Global HIV/AIDS Pandemic. Final Report July 5-6, 1996.
- Raviglione MC, Snider DE, Kochi A. Global epidemiology of tuberculosis ; morbidity and mortality of a worldwide epidemic. JAMA 1995 ; 273 : 220-226.
- Fee MJ, MM, Gabayan AE, Radin DR, Barnes PF. Abdominal tuberculosis in patients infected with human immunodeficiency virus. Clin Infect Dis 1995; 20 : 938-44.
- Perlman DC, el-Sadr WWM, Nelson ET et al. Variation of chest radiographic patterns in pulmonary tuberculosis by degree of human mmunodeficiency virus related immuosuppression ; the Terry Beirn Community Programs for Clinical Research on AIDS (CPCRA). Clin Infedt Dis. 1997 ; 25 : 142 – 6.
- Thwaies, G.E., T.H. Tran. Tuberculous meningitits: many questions, too few answers. Lancet Neurol 2005 ; 4 : 160-70.
- Aaron L, Saadoun D, Calatroni I, Launay O, Memain N, Vincent V et al. Tuberculosis in HIV-infected patients : a comprehensive review. Clin Microbiol Infect 2004 ; 10 : 388 – 98.
- Berenguer J, Moreno S, Laguna F, Vicente T, Adrados M, Ortega A et al. Tuberculous meningitis in patients infected with the human immunodeficiency virus. N. Engl. J. Med 1992; 326 : 668-72.
- Topley JM, Bamber S, Coovadia HM Corr PD. Tuberculous meningitis and coinfection with HIV. Ann. Trop Paediatr. 1998 ; 18 : 261-6.
- Thwaites GE, Duc Bang N, Huy Dung N, Thi Quy H, Thi Toung Oah D, Thi Cam Thoa N, et al. The influence of HIV infection on clinical presentation, response to treatment, and outcome in adults with Tuberculous meningitis. J. Infect Dis 2005 ; 195 : 2134 – 41.
- Dube MP, Holtom PD, Larsen RA. Tuberculous meningitis in patients with and without human immunodeficiency virus infection. Am. J. Med. 1992 ; 93 : 520 – 4.
- Katak SM, Shembalkar PK, Bijwe SR, Bhandarkar LD. The clinical radiological and pathological profile of tuberculous meningitis in patients with and without human immunodeficiency virus infection. J. Neurol Sci. 2000 ; 181 : 118 – 26.
- Torok ME, Chau TT, Mai PP, Phong ND, Dung NT, Chuong LV et al. Clinical and microbiological features of HIV-associated tuberculous meningitis in Vietamese adults.PLoS One 2008 ; 3 :e 1772.
- Sharma HK, Gupta SK, Tuberculous Meningitis – A clinic-Radiological Study. JK Science 2013; 15 : 198-201.
- Bandhopadhyay SK, Bandyoipadhyay R, Dutta A. Profile of tuberculous meningitis with or without HIV infection and the predicators of adverse outcome. The West Indian Medical Journal 2009; 58(6) : 589-92.
- Luma et al. Tuberculous meningitis: presentation, diagnosis and outcome in HIV-infected patients at the douala general hospital, Cameroon : a cross sectional study. AIDS Research and Therapy 2013 ; 10 : 16.
- Cecchini D, Ambrosioni J, Brezzo C, Corti M, Rybko A, Perez M et al. Tuberculous meningitis in HIV-infected and non-infected patients: comparison of cerebrospinal fluid findings. Int. J. Tuberc Lung Dis. 2009 ; 13 : 269-71.
Corresponding Author
Dr Tejpal Singh
Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Mob: 9897487984
DOI: https://dx.doi.org/10.18535/jmscr/v6i12.165
