Tuberculous meningitis in HIV-infected patients in Brazil: clinical and laboratory characteristics and factors associated with mortality.
BACKGROUND
Tuberculous meningitis (TBM) is a growing problem in HIV-infected patients in developing countries, where there is scarce data about this co-infection. Our objectives were to analyze the main features and outcomes of HIV-infected patients with TBM.


METHODS
This was a retrospective study of HIV-infected Brazilian patients admitted consecutively for TBM. All patients had Mycobacterium tuberculosis isolated from the cerebrospinal fluid (CSF). Presenting clinical and laboratory features were studied. Multivariate analysis was used to identify variables associated with death during hospitalization and at 9 months after diagnosis. Survival was estimated using the Kaplan-Meier method.


RESULTS
We included 108 cases (median age 36 years, 72% male). Only 15% had fever, headache, and meningeal signs simultaneously. Forty-eight percent had extrameningeal tuberculosis. The median CD4+ cell count was 65 cells/microl. Among 90 cases, 7% had primary resistance to isoniazid and 9% presented multidrug-resistant strains. The overall mortality during hospitalization was 29% and at 9 months was 41%. Tachycardia and prior highly active antiretroviral therapy (HAART) were associated with 9-month mortality. The 9-month survival rate was 22% (95% confidence interval 12-43%).


CONCLUSIONS
Clinical and laboratory manifestations were unspecific. Disseminated tuberculosis and severe immunosuppression were common. Mortality was high and the 9-month survival rate was low. Tachycardia and prior HAART were associated with death within 9 months of diagnosis.
Croda
Mariana G
MG
Department of Infectious Diseases, Emílio Ribas Institute of Infectious Diseases, Sao Paulo, Brazil.
Vidal
José E
JE
Hernández
Adrián V
AV
Dal Molin
Tiago
T
Gualberto
Felipe A
FA
de Oliveira
Augusto C Penalva
AC
D017088:AIDS-Related Opportunistic Infections / Q000382:microbiology / Q000401:mortality / Q000503:physiopathology; D000293:Adolescent; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D002555:Cerebrospinal Fluid / Q000382:microbiology; D002648:Child; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D015996:Survival Rate; D014390:Tuberculosis, Meningeal / Q000150:complications / Q000382:microbiology / Q000401:mortality* / Q000503:physiopathology; D055815:Young Adult