Clinical and microbiological features of HIV-associated tuberculous meningitis in Vietnamese adults.
Clinical and microbiological features of HIV-associated tuberculous meningitis in Vietnamese adults.
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DOI：
10.1371/journal.pone.0001772
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发表时间：
2008-03-19
期刊：
影响因子：
3.7
通讯作者：
Farrar JJ
中科院分区：
文献类型：
--
作者：
Torok ME;Chau TT;Mai PP;Phong ND;Dung NT;Chuong LV;Lee SJ;Caws M;de Jong MD;Hien TT;Farrar JJ
这项前瞻性、观察性队列研究的目的是确定患有 HIV 相关结核性脑膜炎 (TBM) 的越南成年人的临床和微生物学特征、结果以及预测死亡的基线变量。 58名患者被送往胡志明市热带病医院接受常规临床和实验室评估。治疗采用标准抗结核治疗和辅助地塞米松；抗逆转录病毒疗法并不常规可用。对患者进行随访直至结核病治疗结束或死亡。中位症状持续时间为 11 天（范围 2-90 天），21.8% 有结核病史，41.4% 有严重（3 级）TBM。 CD4 计数中位数为 32 个细胞/mm3。脑脊液检查结果如下：中位白细胞计数438×109细胞/升（中性粒细胞63%），涂片阳性69%，培养阳性87.9%。结核病耐药率很高（单一耐药性为13%，多重耐药性为32.6%，多重耐药性为8.7%）。 17% 的患者出现进一步的艾滋病定义疾病。 67.2% 死亡（中位死亡时间 20 天）。通过多变量分析，三个基线变量可预测死亡：TBM 等级升高[调整后风险比 (AHR) 1.73，95% CI 1.08–2.76，p = 0.02]、血清钠降低（AHR 0.93，95% CI 0.89 至 0.98，p = 0.002）和脑脊液淋巴细胞百分比降低 (AHR) 0.98，95% CI 0.97 至 0.99，p = 0.003）。与 HIV 相关的 TBM 是一种毁灭性的疾病，预后不佳。脑脊液检查结果包括脑脊液中性粒细胞占优势、涂片和培养阳性率高以及抗结核药物耐药率高。三个基线变量与死亡独立相关：TBM 等级增加；低血清钠和降低脑脊液淋巴细胞百分比。
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. 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/mm3. CSF findings were as follows: median leucocyte count 438×109cells/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). 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.
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DOI：
10.1164/ajrccm.155.1.9001331
发表时间：
1997-01-01
影响因子：
24.7
作者：
Burman, WJ;Stone, BL;Cave, MD
通讯作者：
Cave, MD
影响因子：
5.9
作者：
DUBE, MP;HOLTOM, PD;LARSEN, RA
通讯作者：
LARSEN, RA
影响因子：
5.1
作者：
Garg, RK
通讯作者：
Garg, RK
影响因子：
13.3
作者：
Karstaedt, AS;Valtchanova, S;Crewe-Brown, HH
通讯作者：
Crewe-Brown, HH
DOI：
10.1164/ajrccm.158.1.9712001
发表时间：
1998-07-01
影响因子：
24.7
作者：
Narita, M;Ashkin, D;Pitchenik, AE
通讯作者：
Pitchenik, AE