Clinical and microbiological features of HIV-associated tuberculous meningitis in Vietnamese adults.Report as inadecuate




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Reference: Torok, ME, Chau, TT, Mai, PP et al., (2008). Clinical and microbiological features of HIV-associated tuberculous meningitis in Vietnamese adults. PloS one, 3 (3), Article: e1772.Citable link to this page:

 

Clinical and microbiological features of HIV-associated tuberculous meningitis in Vietnamese adults.

Abstract: METHODS: The aim of this prospective, observational cohort study was to determine the clinical and microbiological features, outcome, and baseline variables predictive of death, in Vietnamese adults with HIV-associated tuberculous meningitis (TBM). 58 patients were admitted to the Hospital for Tropical Diseases in Ho Chi Minh City and underwent routine clinical and laboratory assessments. Treatment was with standard antituberculous therapy and adjunctive dexamethasone; antiretroviral therapy was not routinely available. Patients were followed up until the end of TB treatment or death. RESULTS: The median symptom duration was 11 days (range 2-90 days), 21.8% had a past history of TB, and 41.4% had severe (grade 3) TBM. The median CD4 count was 32 cells/mm(3). CSF findings were as follows: median leucocyte count 438 x 10(9)cells/l (63% neutrophils), 69% smear positive and 87.9% culture positive. TB drug resistance rates were high (13% mono-resistance 32.6% poly-resistance 8.7% multidrug resistance). 17% patients developed further AIDS-defining illnesses. 67.2% died (median time to death 20 days). Three baseline variables were predictive of death by multivariate analysis: increased TBM grade [adjusted hazard ratio (AHR) 1.73, 95% CI 1.08-2.76, p = 0.02], lower serum sodium (AHR 0.93, 95% CI 0.89 to 0.98, p = 0.002) and decreased CSF lymphocyte percentage (AHR 0.98, 95% CI 0.97 to 0.99, p = 0.003). CONCLUSIONS: HIV-associated TBM is devastating disease with a dismal prognosis. CSF findings included CSF neutrophil predominance, high rates of smear and culture positivity, and high rates of antituberculous drug resistance. Three baseline variables were independently associated with death: increased TBM grade; low serum sodium and decreased CSF lymphocyte percentage.

Peer Review status:Peer reviewedPublication status:PublishedVersion:Publisher's version Funder: Wellcome Trust   Notes:Copyright 2008 Torok et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Bibliographic Details

Publisher: Public Library of Science

Publisher Website: http://www.plos.org

Journal: PloS onesee more from them

Publication Website: http://www.plosone.org

Issue Date: 2008

pages:Article: e1772Identifiers

Urn: uuid:2fe85c5b-e52c-4a7a-8eed-2e3aa3281663

Source identifier: 92770

Eissn: 1932-6203

Doi: https://doi.org/10.1371/journal.pone.0001772

Issn: 1932-6203 Item Description

Type: Journal article;

Language: eng

Version: Publisher's versionKeywords: Humans AIDS-Related Opportunistic Infections Tuberculosis, Meningeal Antitubercular Agents Prevalence Cohort Studies Drug Therapy, Combination Adult Middle Aged Vietnam Female Male Tiny URL: pubs:92770

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Author: Torok, ME - institutionUniversity of Oxford - - - Chau, TT - - - Mai, PP - - - Phong, ND - - - Dung, NT - - - Chuong, LV - - - Le

Source: https://ora.ox.ac.uk/objects/uuid:2fe85c5b-e52c-4a7a-8eed-2e3aa3281663



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