Clinical features of the course of tuberculous meningitis in HIV-infected patients
- Authors: Babaeva I.Y.1,2, Shevchenko A.I.1, Dudchenko D.V.1, Tolochko C.A.1, Romantsov V.V.1, Nartov E.O.1
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Affiliations:
- Kuban State Medical University
- Clinical Tuberculosis Dispensary, Krasnodar
- Issue: Vol 25, No 9 (2023): Otorhinolaryngology and pulmonology
- Pages: 558-564
- Section: Articles
- URL: https://journals.rcsi.science/2075-1753/article/view/253569
- DOI: https://doi.org/10.26442/20751753.2023.9.202331
- ID: 253569
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Abstract
Background. Central nervous system tuberculosis is one of the most severe forms of extrapulmonary tuberculosis, which is due to an unfavorable clinical course, a high incidence of neurological complications and deaths. Despite this, the problem of early diagnosis is still not solved.
Aim. To study the clinical and laboratory-instrumental features of the early diagnosis of tuberculous meningitis in HIV-infected patients.
Materials and methods. A retrospective analysis of 31 case histories of patients with tuberculous lesions of the meninges and central nervous system in the late stages of HIV infection who were treated at the Clinical Tuberculosis Dispensary of Krasnodar Territory in 2020–2022 was carried out. The data of clinical manifestations of the disease, the results of laboratory and instrumental methods of examination were analyzed. Statistical data processing was performed by Microsoft Office Excel 2021 with the calculation of averages, standard deviation.
Results. Tuberculous lesions of the meninges and the central nervous system among HIV-infected people were more common in men of working age who were not previously registered in a tuberculosis dispensary. All HIV-infected patients had late stages of HIV infection with severe immunodeficiency: the content of CD4+ lymphocytes less than 100 cells was detected in 45.46%; from 100 to 200 cells/µl of CD4+ lymphocytes were recorded in 36.36%, more than 200 cells/µl in 18.18%. Also, in all the studied patients, the primary focus was established in the form of tuberculosis of the respiratory organs, represented in 56.52% of cases by disseminated pulmonary tuberculosis. More than 70% had generalized tuberculosis with damage to the kidneys, spleen, and peripheral lymph nodes. A feature of the manifestation of tuberculous meningitis in HIV-infected people can be considered a high frequency of acute increase in neurological symptoms. Of the cerebral manifestations, the most common were: headache, dizziness, photophobia. 13.04% of HIV-infected patients complained of nausea and vomiting. 91.30% showed signs of damage to the substance of the brain, represented by mono-, hemiparesis and damage to the cranial nerves, mainly III–IV, VI, VII pairs. The composition of CSF in HIV-positive patients revealed the presence of mild pleocytosis (up to 100 cells/µl) in 56.52% of cases. The nature of the change in the concentration of proteins, chlorides and glucose is nonspecific.
Conclusions. The study revealed the features of medical and social characteristics, clinical and laboratory and instrumental picture of tuberculous meningitis in HIV-infected patients and without HIV infection.
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##article.viewOnOriginalSite##About the authors
Irina Y. Babaeva
Kuban State Medical University; Clinical Tuberculosis Dispensary, Krasnodar
Author for correspondence.
Email: irenb74@mail.ru
ORCID iD: 0000-0002-0369-0321
D. Sci. (Med.), Kuban State Medical University, Clinical Tuberculosis Dispensary
Russian Federation, KrasnodarAndrey I. Shevchenko
Kuban State Medical University
Email: irenb74@mail.ru
ORCID iD: 0000-0002-9845-4806
Cand. Sci. (Med.), Kuban State Medical University
Russian Federation, KrasnodarDiana V. Dudchenko
Kuban State Medical University
Email: irenb74@mail.ru
Аssistant, Kuban State Medical University
Russian Federation, KrasnodarChristina A. Tolochko
Kuban State Medical University
Email: irenb74@mail.ru
ORCID iD: 0009-0001-8172-5374
Laboratory Assistant, Kuban State Medical University
Russian Federation, KrasnodarVictor V. Romantsov
Kuban State Medical University
Email: irenb74@mail.ru
ORCID iD: 0000-0001-7218-6164
Laboratory Assistant, Kuban State Medical University
Russian Federation, KrasnodarEgor O. Nartov
Kuban State Medical University
Email: irenb74@mail.ru
ORCID iD: 0009-0009-6216-4354
Laboratory Assistant, Kuban State Medical University
Russian Federation, KrasnodarReferences
- Синицын М.В., Богородская Е.М., Родина О.В., и др. Поражение центральной нервной системы у больных туберкулезом в современных эпидемических условиях. Инфекционные болезни: новости, мнения, обучение. 2018;7(1):111-20 [Sinitsyn MV, Bogorodskaya EM, Rodina OV, et al. The damage of the central nervous system in the patients with tuberculosis in modern epidemiological conditions. Infectious Diseases: News, Opinions, Training. 2018;7(1):111-20 (in Russian)]. doi: 10.24411/2305-3496-2018-00015
- Global tuberculosis report 2022. Geneva: World Health Organization, 2022.
- Астрелин А.М. Тенденции заболеваемости, распространенности и смертности от ВИЧ-инфекции и туберкулеза в регионах России в XXI веке. Демографическое обозрение. 2020;7(4):82-107 [Astrelin AM. Tendentsii zabolevaemosti, rasprostranennosti i smertnosti ot VICh-infektsii i tuberkuleza v regionakh Rossii v XXI veke. Demograficheskoe obozrenie. 2020;7(4):82-107 (in Russian)]. doi: 10.17323/demreview.v7i4.12045
- Афанасьев Е.И., Русских О.Е. Современные тенденции в эпидемиологии туберкулеза и ВИЧ-инфекции в мире и в Российской Федерации. РМЖ. 2021;3:24-6 [Afanasiev EI, Russkikh OE. Modern trends in the epidemiology of tuberculosis and HIV infection worldwide and in the Russian Federation. RMJ. 2021;3:24-6 (in Russian)].
- Чумаченко Г.В., Бабаева И.Ю., Авдеева М.Г. Актуальность проблемы сочетанной инфекции ВИЧ и туберкулеза в современных эпидемиологических условиях. Эпидемиология и инфекционные болезни. 2016;21(6):304-12 [Chumachenko GV, Babaeva IYu, Avdeeva MG. The actuality of the problem co-infection of HIV and tuberculosis in current epidemiological conditions. Epidemiology and Infectious Diseases (Russian journal). 2016;21(6):304-12 (in Russian)]. doi: 10.18821/1560-9529-2016-21-6-304-312
- Мальцева Н.В., Викторова И.Б., Казанцева О.М., и др. Иммуноглобулины и предикция летальности при клиническом течении коинфекции ВИЧ и туберкулеза. Инфекция и иммунитет. 2021;11(3):539-48 [Maltseva NV, Viktorova IB, Kazantseva OM, et al. Immunoglobulins and predicted mortality in clinical course of concomitant HIV and TB infection. Russian Journal of Infection and Immunity. 2021;11(3):539-48 (in Russian)]. doi: 10.15789/2220-7619-IAP-1366
- Корсунский И.А., Кудлай Д.А. Диагностика и контроль клеточного иммунитета пациентов с туберкулезом. Тихоокеанский медицинский журнал. 2021;2:19-24 [Korsunskiy IA, Kudlay DA. Diagnostics and control of cellular immunity of patients having tuberculosis. Pacific Medical Journal. 2021;2:19-24 (in Russian)]. doi: 10.34215/1609-1175-2021-2-19-24
- Soni N, Kumar S, Shimle A, et al. Cerebrovascular complications in tuberculous meningitis – A magnetic resonance imaging study in 90 patients from a tertiary care hospital. Neuroradiol J. 2020;33(1):3-16. doi: 10.1177/1971400919881188
- Wasay M, Khan M, Farooq S, et al. Frequency and Impact of Cerebral Infarctions in Patients with Tuberculous Meningitis. Stroke. 2018;49(10):2288-93. doi: 10.1161/STROKEAHA.118.021301
- Миляев А.А., Данцев В.В., Белова А.И., и др. Особенности клиники и диагностики туберкулезного менингоэнцефалита у пациентов, инфицированных вирусом иммунодефицита человека. Вестник Российской Военно-медицинской академии. 2020;22(2):55-8 [Milyaev AA, Dantsev VV, Belova AI, et al. Clinical features and diagnosis of tuberculous meningoencephalitis in patients infected with human immunodeficiency virus. Bulletin of the Russian Military Medical Academy. 2020;22(2):55-8 (in Russian)]. doi: 10.17816/brmma50046
- Карсканова С.С., Стерьхова Ю.Г., Долгова Н.А., и др. Туберкулезные менингиты: трудности диагностики и лечения. Уральский медицинский журнал. 2018;8:37-40 [Karskanova SS, Sterchova UG, Dolgova NA, et al. Tuberculous meningitis: difficulties in diagnosis and treatment. Ural Medical Journal. 2018;8:37-40 (in Russian)]. doi: 10.25694/URMJ.2018.04.121
- Корсунская Л.Л., Шиян С.В. Атипичные варианты течения туберкулезного менингоэнцефалита на фоне ВИЧ-инфекции. Международный неврологический журнал. 2008;6(22):131-5 [Korsunskaya LL, Shiyan SV. Atypical course of tuberculous meningoencephalitis in patients with HIV infection. International Neurological Journal. 2008;6(22):131-5 (in Russian)].
- Кичерова О.А., Рейхерт Л.И., Иванова Е.Е., и др. Случай туберкулезного менингоэнцефаломиелита. Журнал неврологии и психиатрии им. С.С. Корсакова. 2022;122(4):135-43 [Kicherova OA, Reikhert LI, Ivanova EE, et al. A case of tuberculous meningoencephalomyelitis. Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 2022;122(4):135-43 (in Russian)]. doi: 10.17116/jnevro2022122041135
- Корж Е.В., Подчос Н.А. Туберкулезный менингит у больных с сочетанием туберкулеза и ВИЧ-инфекции, начавших антиретровирусную терапию: особенности течения и прогноз. Туберкулез и болезни легких. 2019;97(9):5-10 [Korzh EV, Podchos NA. Tuberculous meningitis in patients with concurrent tuberculosis and HIV infection who have started antiretroviral therapy: the specific course and prognosis. Tuberculosis and Lung Diseases. 2019;97(9):5-10 (in Russian)]. doi: 10.21292/2075-1230-2019-97-9-5-10
- Комиссарова О.Г., Абдуллаев Р.Ю., Герасимов Л.Н., и др. ВИЧ-ассоциированный туберкулез: особенности течения и эффективность лечения (обзор литературы). Уральский медицинский журнал. 2018;8:41-6 [Komissarova OG, Abdullaev RYu, Gerasimov LN, et al. HIV-associated tuberculosis: the course of the tuberculosis process and efficacy of treatment (Review). Ural Medical Journal. 2018;8:41-6 (in Russian)]. doi: 10.25694/URMJ.2018.05.49
- Мальцева Н.В. Защитная роль антител при туберкулезе и ВИЧ-инфекции. Медицина в Кузбассе. 2022;21(3):106-10 [Maltseva NV. Protective role of antibodies in tuberculosis and HIV infection. Medicine in Kuzbass. 2022;21(3):106-10 (in Russian)]. doi: 10.24412/2687-0053-2022-3-106-110
- Feng GD, Shi M, Ma L, et al. Diagnostic accuracy of intracellular mycobacterium tuberculosis detection for tuberculous meningitis. Am J Resp Crit Care Med. 2014;189(4):475-81. doi: 10.1164/rccm.201309-1686OC
- Stadelman AM, Ssebambulidde K, Buller A, et al. Cerebrospinal Fluid AFB Smear in Adults with Tuberculous Meningitis: A Systematic Review and Diagnostic Test Accuracy Meta-Analysis. Tuberculosis (Edinb). 2022;135:102230. doi: 10.1016/j.tube.2022.102230