[Persistent neutrophilic meningitis in a patient with the acquired immunodeficiency syndrome].
Persistent neutrophilic meningitis is rarely found and it is characterized by predominance of the number of neutrophils in samples of C SF (cerebrospinal fluid) from the patient after seven days of treatment. The above patient in HIV positive; he has developed fever and mental disorder for 4 months and has presented neutrophilic pleocytosis in analysis of CSF for more than 5 months. Since the beginning or the treatment he has taken antituberculous drugs and corticosteroids. For 3 months, the serologic evaluation, smears and cultures were negative. On the 60th day in hospital, the investigation of acid-fast bacilli in CSF was positive and culture confirmed the presence of Mycobacterium tuberculosis resistant to isoniazid. Several factors that may have caused this uncommon development were discussed: the disturbance of cell-mediated immunity, mainly in release of IL 8 and TNF, the simultaneous use of medicines that could alter the CSF concentration of antituberculous drugs, and the increasing number of multiresistant strains.
Marinho
S F
SF
Instituto de Infectologia Emilio Ribas, São Paulo, Brasil.
Paciullo
V H
VH
Fonseca
M O
MO
Khoury
Z
Z
Yamin
M A
MA
Minkoves
R
R
Andrade
M O
MO
Cavallari
M M
MM
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis; D000163:Acquired Immunodeficiency Syndrome / Q000134:cerebrospinal fluid / Q000150:complications*; D000328:Adult; D002555:Cerebrospinal Fluid / Q000166:cytology; D017809:Fatal Outcome; D015497:HIV-1; D006801:Humans; D008297:Male; D008581:Meningitis / Q000134:cerebrospinal fluid / Q000175:diagnosis*; D009504:Neutrophils; D015819:Substance Abuse, Intravenous / Q000150:complications; D013997:Time Factors; D014390:Tuberculosis, Meningeal / Q000175:diagnosis