Berenguer J, Moreno S, Laguna F, Vicente T, Adrados M, Ortega A, González-LaHoz J, Bouza E
Department of Clinical Microbiology and Infectious Diseases, Hospital General Gregorio Marañón, Madrid, Spain.
N Engl J Med. 1992 Mar 5;326(10):668-72. doi: 10.1056/NEJM199203053261004.
Tuberculosis is a frequent complication of human immunodeficiency virus (HIV) infection. We describe the clinical manifestations and outcomes of tuberculous meningitis in patients with HIV infection, and compare them with those in non-HIV-infected patients. We reviewed the records from 1985 through 1990 at two large referral hospitals in Madrid for patients who had Mycobacterium tuberculosis isolated from cerebrospinal fluid.
Of 2205 patients with tuberculosis, 455 (21 percent) also had HIV infection, of whom 45 had M. tuberculosis isolated from the cerebrospinal fluid. Of the 37 HIV-infected patients with tuberculous meningitis for whom records were available, 24 (65 percent) had clinical or radiologic evidence of extrameningeal tuberculosis at the time of admission. In 18 of 26 patients (69 percent), a CT scan of the head was abnormal. In most patients, analysis of cerebrospinal fluid showed pleocytosis (median white-cell count, 0.234 x 10(9) per liter) and hypoglycorrhachia (median glucose level, 1.3 mmol per liter), but in 43 percent (15 of 35), the level of protein in cerebrospinal fluid was normal. In four patients with HIV infection, tuberculosis was only discovered after their deaths. Of the 33 patients who received antituberculous treatment, 7 died (in-hospital mortality, 21 percent). Illness lasting more than 14 days before admission and a CD4+ cell count of less than 0.2 x 10(9) per liter (200 per cubic millimeter) were associated with a poor prognosis. Comparison with tuberculous meningitis in patients without HIV infection showed that the presentation, clinical manifestations, cerebrospinal fluid findings, and mortality were generally similar in the two groups. However, of the 1750 patients without HIV infection, only 2 percent (38 patients) had tuberculous meningitis, as compared with 10 percent of the HIV-infected patients (P less than 0.001).
HIV-infected patients with tuberculosis are at increased risk for meningitis, but infection with HIV does not appear to change the clinical manifestations or the outcome of tuberculous meningitis.
结核病是人类免疫缺陷病毒（HIV）感染常见的并发症。我们描述了HIV感染患者结核性脑膜炎的临床表现及转归，并将其与未感染HIV的患者进行比较。我们回顾了1985年至1990年马德里两家大型转诊医院中脑脊液分离出结核分枝杆菌患者的病历。
在2205例结核病患者中，455例（21%）同时感染了HIV，其中45例脑脊液中分离出结核分枝杆菌。在有记录的37例HIV感染的结核性脑膜炎患者中，24例（65%）入院时有脑膜外结核的临床或影像学证据。26例患者中有18例（69%）头部CT扫描异常。大多数患者脑脊液分析显示细胞数增多（白细胞计数中位数为每升0.234×10⁹）和脑脊液低糖（葡萄糖水平中位数为每升1.3 mmol），但43%（35例中的15例）脑脊液蛋白水平正常。4例HIV感染患者在死后才发现患有结核病。在33例接受抗结核治疗的患者中，7例死亡（院内死亡率为21%）。入院前病程超过14天及CD4⁺细胞计数低于每升0.2×10⁹（每立方毫米200个）与预后不良相关。与未感染HIV的患者的结核性脑膜炎相比，两组的表现、临床表现、脑脊液检查结果及死亡率总体相似。然而，在1750例未感染HIV的患者中，只有2%（38例）患有结核性脑膜炎，而HIV感染患者中这一比例为10%（P<0.001）。
HIV感染的结核病患者患脑膜炎的风险增加，但HIV感染似乎并未改变结核性脑膜炎的临床表现或转归。
