Presentation and outcome of tuberculous meningitis in a high HIV prevalence setting.
Presentation and outcome of tuberculous meningitis in a high HIV prevalence setting.
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DOI：
10.1371/journal.pone.0020077
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发表时间：
2011
期刊：
影响因子：
3.7
通讯作者：
Meintjes G
中科院分区：
文献类型：
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作者：
Marais S;Pepper DJ;Schutz C;Wilkinson RJ;Meintjes G
结核分枝杆菌是艾滋病毒感染者脑膜炎的常见、破坏性原因。由于国际推广计划，抗逆转录病毒治疗（ART）的可及性正在全球范围内增加。艾滋病毒相关结核性脑膜炎（TBM）患者在结核病（TB）治疗期间开始接受抗逆转录病毒治疗可能会增加这些患者的生存率。我们进行了这项研究，以描述在高HIV/TB合并感染环境中的二级医院发生脑膜炎的原因，并确定结核性脑膜炎患者死亡率的预测因素。对六个月期间（2009年3月- 2009年8月）的脑脊液检查结果和临床记录进行回顾性审查。根据公布的病例定义诊断明确、可能和可能的TBM。211例脑膜炎患者中有120例（57%）被诊断为TBM。在106例感染艾滋病毒的结核性结核患者中，在结核治疗期间接受抗逆转录病毒治疗（ART）的患者6个月全因死亡率较低；风险比= 0.30 （95% CI = 0.08-0.82）。与hiv感染患者住院死亡率相关的因素有：1)入院时CD4+计数低；校正优势比（AOR) = 1.4（95%可信区间[CI] = 1.03-1.96）每50个细胞/µL CD4+计数下降，2）更高的英国医学研究委员会TBM疾病等级（2或3比1）；Aor = 4.8 （95% ci = 1.45-15.87）。在结核病治疗之前或期间开始抗逆转录病毒治疗可能与艾滋病毒相关结核性脑膜炎患者死亡率降低有关。晚期HIV和TBM疾病的恶化阶段预测TBM患者的住院死亡率。
Mycobacterium tuberculosis is a common, devastating cause of meningitis in HIV-infected persons. Due to international rollout programs, access to antiretroviral therapy (ART) is increasing globally. Starting patients with HIV-associated tuberculous meningitis (TBM) on ART during tuberculosis (TB) treatment may increase survival in these patients. We undertook this study to describe causes of meningitis at a secondary-level hospital in a high HIV/TB co-infection setting and to determine predictors of mortality in patients with TBM. A retrospective review of cerebrospinal fluid findings and clinical records over a six-month period (March 2009–August 2009). Definite, probable and possible TBM were diagnosed according to published case definitions. TBM was diagnosed in 120/211 patients (57%) with meningitis. In 106 HIV-infected patients with TBM, six-month all-cause mortality was lower in those who received antiretroviral therapy (ART) during TB treatment; hazard ratio = 0.30 (95% CI = 0.08–0.82). Factors associated with inpatient mortality in HIV-infected patients were 1) low CD4+ count at presentation; adjusted odds ratio (AOR) = 1.4 (95% confidence interval [CI] = 1.03–1.96) per 50 cells/µL drop in CD4+ count and, 2) higher British Medical Research Council TBM disease grade (2 or 3 versus 1); AOR = 4.8 (95% CI = 1.45–15.87). Starting ART prior to or during TB treatment may be associated with lower mortality in patients with HIV-associated TBM. Advanced HIV and worse stage of TBM disease predict in-hospital mortality in patients presenting with TBM.
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DOI：
10.1056/nejmoa0905848
发表时间：
2010-02-25
期刊：
The New England journal of medicine
影响因子：
--
作者：
Abdool Karim SS;Naidoo K;Grobler A;Padayatchi N;Baxter C;Gray A;Gengiah T;Nair G;Bamber S;Singh A;Khan M;Pienaar J;El-Sadr W;Friedland G;Abdool Karim Q
通讯作者：
Abdool Karim Q
影响因子：
3.7
作者：
Jarvis JN;Meintjes G;Williams A;Brown Y;Crede T;Harrison TS
通讯作者：
Harrison TS
影响因子：
11.8
作者：
Pepper, Dominique J.;Marais, Suzaan;Meintjes, Graeme
通讯作者：
Meintjes, Graeme
影响因子：
5.9
作者：
DUBE, MP;HOLTOM, PD;LARSEN, RA
通讯作者：
LARSEN, RA
影响因子：
13.3
作者：
Karstaedt, AS;Valtchanova, S;Crewe-Brown, HH
通讯作者：
Crewe-Brown, HH