Tuberculous meningitis: Comparison of clinical, laboratory and neuroimaging findings between HIV-positive and HIV-negative patients

OBJECTIVES: Determine possible differences in clinical manifestations, laboratory findings and neuroimaging results in tuberculous meningitis patients with and without HIV infection. PATIENTS AND METHODS: We retrospectively reviewed data of 38 patients with positive cerebrospinal fluid clultures for Mycobacterium tuberculosis who were hospitalized in 3 university hospitals in Paris over the last 11 years. RESULTS: There were 24 HIV-infected patients and 14 without HIV infection. Mean CD4 lymphocyte count was 103 +/- 180/mm(3) in the HIV group. Age (median age = 33 years for the HIV-group vs. 53 for the non-HIV group), sex ratio (3 vs. 0.75), and prior history of tuberculosis (46% vs. 43%) were similar in both groups. Clinical presentation was similar for headache (83% in HIV group vs, 50% in non-HIV group; p = 0.02) and confusion (54% vs. 93% in non-HIV group p = 0.05). Serum natremia (mmol/l) (131 +/- 5 vs. 125 +/- 8, P = 0.024), white blood cell count (X 10(9)/l) (5.8 +/- 4.7 vs. 10.7 +/- 17; p = 0.037) and erythrocyte sedementation rate (mm/h) (68 +/- 34 vs. 31 +/- 35; p = 0.003) were significantly different in the 2 groups Median cerebrospinal fluid flindings were similar in the 2 groups: leukocytes (X 10(6)/l) (375 +/- 860 vs 218 +/- 250), glucose (mmol/l) (2.3 +/- 9.9 vs 2.7 +/- 1.9) and protein (g/l) (3.8 +/- 7.1 vs. 2.6 +/- 1.6). CT-scans of the brain were similar in the 2 groups. Mortality during hospitalization was similar (42% vs 36%; NS). CONCLUSION: HIV infection appears to have little impact on the presentation of tuberculous meningitis.