Tuberculous meningitis: presentation, diagnosis and outcome in hiv-infected patients at the douala general hospital, cameroon: a cross sectional study

AIDS Research and Therapy

Henry Namme Luma²  Benjamin Clet Nguenkam Tchaleu³  Bertrand Hugo Mbatchou Ngahane¹  Elvis Temfack⁴  Marie Solange Doualla²  Marie Patrice Halle¹  Henry Achu Joko⁴  Sinata Koulla-Shiro² 

[1] Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon

[2] Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon

[3] Universite des Montagnes, Bagangté, Cameroon

[4] Internal Medicine Unit, Douala General Hospital, Douala, Cameroon

关键词: HIV;    Hydrocephalus;    Cerebrospinal fluid;    Tuberculous meningitis;   

Others  :  789589
DOI  :  10.1186/1742-6405-10-16

 received in 2013-01-30, accepted in 2013-06-06,  发布年份 2013

【 摘 要 】

Introduction

Tuberculous meningitis (TBM) the most fatal presentation of tuberculosis (TB) especially in HIV-infected patients is a real diagnostic and therapeutic challenge worldwide. In Cameroon where HIV and TB are amongst the leading public health problems, the magnitude of TBM has not been defined. Therefore, the objective of this cross sectional study was to describe the presentation and in-hospital outcome of TBM among HIV patients in Douala as well as its diagnostic difficulties.

Methods

We did a clinical case note analysis of all HIV-1 infected patients treated for TBM in the Internal medicine unit of the Douala General Hospital, between January 1^st 2004 and December 31^st 2009. The diagnosis of TBM was made using clinical, laboratory [cerebrospinal fluid (CSF) analysis] and/or brain computerised tomographic (CT) scan features.

Results

During the study period, 8% (54/672) of HIV-infected patients had TBM. Their mean age was 40.3 ± 12.7 years. The main presenting complaint was headache in 74.1% (40/54) of patients. Their median CD4 cell count was 16 cells/mm³ (IQR: 10 – 34). CSF analysis showed median protein levels of 1.7 g/l (IQR: 1.3 – 2.2), median glucose level of 0.4 g/l (IQR: 0.3 – 0.5) and median white cell count (WCC) count of 21 cells/ml (IQR: 12 – 45) of which mononuclear cells were predominant in 74% of CSF. Acid fast bacilli were found in 1.9% (1/54) of CSF samples. On CT scan hydrocephalus was the main finding in 70.6% (24/34) of patients. In hospital case fatality was 79.6% (43/54).

Conclusion

TBM is a common complication in HIV-infected patients in Douala with high case fatality. Its presumptive diagnosis reposes mostly on CSF analysis, so clinicians caring for HIV patients should not hesitate to do lumbar taps in the presence of symptoms of central nervous system disease.

【 授权许可】

   
2013 Luma et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Marais S, Pepper DJ, Marais BJ, Torok ME: HIV-associated tuberculous meningitis–diagnostic and therapeutic challenges. Tuberculosis 2010, 90(6):367-374.
• [2]Thwaites GE, Tran TH: Tuberculous meningitis: many questions, too few answers. Lancet Neurol 2005, 4(3):160-170.
• [3]Joint United Nations Programme on HIV/AIDS: Report on the global HIV/AIDS epidemic. Geneva; Switzerland: UNAIDS; 2011. [Accessed November 20th 2012]. Available from http://www.unaids.org/en/media/unaids/contentassets/documents/unaidspublication/2011/jc2216_worldaidsday_report_2011_en.pdf
• [4]Ganiem AR, Parwati I, Wisaksana R, van der Zanden A, van de Beek D, Sturm P, et al.: The effect of HIV infection on adult meningitis in Indonesia: a prospective cohort study. AIDS 2009, 23(17):2309-2316.
• [5]World Health Organisation: Global tuberculosis control 2011. 2011. Available from: http://whqlibdoc.who.int/publications/2011/9789241564380_eng.pdf webcite
• [6]Sume GE, Etogo D, Kabore S, Gnigninanjouena O, Epome SS, Metchendje JN: Seroprevalence of human immunodeficiency virus infection among tuberculosis patients in the Nylon district hospital tuberculosis treatment centre. East Afr Med J 2008, 85(11):529-536.
• [7]Pefura Yone EW, Kuaban C, Simo L: [Tuberculous pleural effusion in Yaounde, Cameroon: The influence of HIV infection]. Rev Mal Respir 2011, 28(9):1138-1145.
• [8]Vinnard C, Macgregor RR: Tuberculous meningitis in HIV-infected individuals. Curr HIV/AIDS Rep 2009, 6(3):139-145.
• [9]Torok ME, Yen NT, Chau TT, Mai NT, Phu NH, Mai PP, et al.: Timing of initiation of antiretroviral therapy in human immunodeficiency virus (HIV)–associated tuberculous meningitis. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America 2011, 52(11):1374-1383.
• [10]George EL, Iype T, Cherian A, Chandy S, Kumar A, Balakrishnan A, et al.: Predictors of mortality in patients with meningeal tuberculosis. Neurol India 2012, 60(1):18-22.
• [11]Brancusi F, Farrar J, Heemskerk D: Tuberculous meningitis in adults: a review of a decade of developments focusing on prognostic factors for outcome. Future Microbiol 2012, 7(9):1101-1116.
• [12]Donald PR, Schaaf HS, Schoeman JF: Tuberculous meningitis and miliary tuberculosis: the Rich focus revisited. J Infect 2005, 50(3):193-195.
• [13]Roca B, Tornador N, Tornador E: Presentation and outcome of tuberculous meningitis in adults in the province of Castellon, Spain: a retrospective study. Epidemiol Infect 2008, 136(11):1455-1462.
• [14]Loubiere S, Boyer S, Protopopescu C, Bonono CR, Abega SC, Spire B, et al.: Decentralization of HIV care in Cameroon: increased access to antiretroviral treatment and associated persistent barriers. Health Policy 2009, 92(2–3):165-173.
• [15]Cameroon National Tuberculosis Strategic plan 2010–2014. Yaoundé, Cameroon: Ministry of Public Health; 2011. Available from: http://minsante-cdnss.cm/sites/minsantecdnss.cm/files/biblio/2011/nationaltuberculosisstrategicplan2010.pdf webcite
• [16]PLAN STRATEGIQUE NATIONAL DE LUTTE CONTRE LE VIH, LE SIDA ET LES IST. Yaounde, Cameroon: NATIONAL AIDS CONTROL COMMITTEE, Ministry of Public Health; 2011. Available from: http://minsante-cdnss.cm/sites/minsantecdnss.cm/files/biblio/fr/2012/2010-cnls-psn20112015draftfinal17aoutok.pdf webcite
• [17]Medical Research Council. Streptomycin in Tuberculosis Trials Committee, STREPTOMYCIN treatment of tuberculous meningitis Lancet 1948, 1(6503):582-596.
• [18]Berhe T, Melkamu Y, Amare A: The pattern and predictors of mortality of HIV/AIDS patients with neurologic manifestation in Ethiopia: a retrospective study. AIDS Res Ther 2012, 9:11. BioMed Central Full Text
• [19]Tan IL, Smith BR, von Geldern G, Mateen FJ, McArthur JC: HIV-associated opportunistic infections of the CNS. Lancet Neurol 2012, 11(7):605-617.
• [20]Garg RK, Sinha MK: Tuberculous meningitis in patients infected with human immunodeficiency virus. J Neurol 2011, 258(1):3-13.
• [21]Pasco PM: Diagnostic features of tuberculous meningitis: a cross-sectional study. BMC research notes 2012, 5:49. BioMed Central Full Text
• [22]Iseman MD: A clinician's guide to Tuberculosis. Baltimore, Md, USA: Lippincott Williams & Wilkins; 1999.
• [23]Thwaites GE, Chau TT, Farrar JJ: Improving the bacteriological diagnosis of tuberculous meningitis. J Clin Microbiol 2004, 42(1):378-379.
• [24]Christensen AS, Andersen AB, Thomsen VO, Andersen PH, Johansen IS: Tuberculous meningitis in Denmark: a review of 50 cases. BMC Infect Dis 2011, 11:47. BioMed Central Full Text
• [25]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(10):668-672.
• [26]Cohen DB, Zijlstra EE, Mukaka M, Reiss M, Kamphambale S, Scholing M, et al.: Diagnosis of cryptococcal and tuberculous meningitis in a resource-limited African setting. Tropical medicine & international health: TM & IH 2010, 15(8):910-917.
• [27]Hosoglu S, Geyik MF, Balik I, Aygen B, Erol S, Aygencel SG, et al.: Tuberculous meningitis in adults in Turkey: epidemiology, diagnosis, clinic and laboratory [corrected]. Eur J Epidemiol 2003, 18(4):337-343.
• [28]Marx GE, Chan ED: Tuberculous meningitis: diagnosis and treatment overview. Tuberculosis research and treatment 2011, 2011:798764.
• [29]Kent SJ, Crowe SM, Yung A, Lucas CR, Mijch AM: Tuberculous meningitis: a 30-year review. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America 1993, 17(6):987-994.
• [30]World Health Organisation: Tuberculosis country profile. Geneva, Switzerland: WHO; 2010. Available from: https://extranet.who.int/sree/Reports?op=Replet&name=%2FWHO_HQ_Reports%2FG2%2FPROD%2FEXT%2FTBCountryProfile&ISO2=CM&outtype=html webcite
• [31]Thwaites GE, Macmullen-Price J, Tran TH, Pham PM, Nguyen TD, Simmons CP, et al.: Serial MRI to determine the effect of dexamethasone on the cerebral pathology of tuberculous meningitis: an observational study. Lancet Neurol 2007, 6(3):230-236.
• [32]Lu CH, Chang WN, Chang HW: The prognostic factors of adult tuberculous meningitis. Infection 2001, 29(6):299-304.
• [33]Cherian A, Thomas SV: Central nervous system tuberculosis. Afr Health Sci 2011, 11(1):116-127.
• [34]Bhagwan S, Naidoo K: Aetiology, clinical presentation, and outcome of meningitis in patients coinfected with human immunodeficiency virus and tuberculosis. AIDS research and treatment 2011, 2011:180352.