Meningitis in HIV-Infected Patients.



Objective: To analyze the etiology and clinical characteristics of meningitis (M) in HIV infected patients. Patients and method: Case definition: HIV-infected patient diagnosed of M from Jan-87 to Dec-97. Definitions: Certain Diagnosis(CD): etiology confirmed by microbiological or/and histological procedures. Uncertain Diagnosis(UD): non confirmed etiology. Acute M (AM):evolution time =4 weeks. We analyzed the etiology of meningitis according to CSF characteristics and evolution time. Results: Cases number: 86. Sex: 72 male. Age (mean): 32 years. Risk practice: 67 IDU, 7 homosexual, 9 heterosexual, 3 others. AIDS clinical criteria before meningitis diagnosis: 50 cases. CD4+ lymphocytes counts mean at the diagnosis: 127/mL. Etiology: 33 (38,4%) UD and CD 53 (61,6%). Etiology of CD cases: 19 Mycobacterium tuberculosis (T), 14 Cryptococcus neoformans (CR), 5 Candida sp. (CA), 5 Bacterias (B), 3 Neoplasms (N), 2 Syphilis (SY), 2 HIV-acute infection (H), 1 Aspergillus fumigatus (AS), 1 Herpes zoster virus (HZ) and 1 M. fortuitum (MF). According to presentation time: 6 AM (2T, 1CA, 1CR, 1N,1UD), 55 SM (4B, 13T, 2CA, 9CR, 2H, 2N, 1AS, 1MF, 21UD) and 25 CM (1B, 4T, 2CA, 4CR, 2SY, 1HZ, 11UD). CSF without pleocytosis: 12 cases (1B, 2T, 7CR, 2UD). CSF with lymphocytic pleocytosis and low glucose: 26 cases (5T, 2 CR, 2CA, 1N, 1AS, 1HZ, 1 B, 13UD), CSF with lymphocytic pleocytosis and normal glucose 17 cases (6 CR, 2 VIH, 1 B, 1T, 7UD). CFS with neutrophilic pleocytosis and low glucose: 21 cases (8 T, 2 B, 2 CA, 1 CR, 1 N, 7 UD). CFS with neutrophilic pleocytosis and normal glucose: 7 cases (3 T, 1 CA, 1 SY, 2 UD). Adenosine deaminase-test (ADA): sensitivity 75% and specificity 80% for tuberculosis diagnosis. Of the 33 cases of UD, 18 received empirical therapy for tuberculosis (8 with increased CFS ADA levels), in 14 of them clinical and CFS response were observed. Mortality: 27,9%. Conclusions: 1. The etiological spectre of M in HIV-infected patients is very wide. 2.- The most frequent etiology in our study was tuberculosis. 3. In 38% of cases the etiology of meningitis was not confirmed. 3. In this series the sensibility of ADA was lower than previously reported in non-HIV infected patients. 4.-The clinical and CFS manifestations of meningitis in HIV patients are most changeable, even for a same etiological agent.

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38th Interscience Conference on Antimicrobial Agents and Chemotherapy
    • ICAAC 38th