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July 1996

Tuberculous Meningitis: Clinical Characteristics and Comparison With Cryptococcal Meningitis in Patients With Human Immunodeficiency Virus Infection

Author Affiliations

From the Department of Neurology (Dr Sánchez-Portocarrero), Human Immunodeficiency Virus Unit (Dr Pérez-Cecilia), Departments of Clinical Microbiology (Drs Martín-Rabadán, Romero-Vivas, and Picazo) and Internal Medicine (Drs Roca, Ruiz Yague, and Palau), Hospital Universitario San Carlos, and Department of Neurology, Hospital Ramón y Cajal (Dr Jiménez-Escrig), Madrid, Spain.

Arch Neurol. 1996;53(7):671-676. doi:10.1001/archneur.1996.00550070109018

Objective:  To determine the prevalence and causes of meningitis in patients with human immunodeficiency virus (HIV) infection.

Design:  A prospective study of HIV-associated neurologic complications carried out from 1988 to 1992.

Setting:  A tertiary care university hospital in Madrid, Spain.

Patients:  A total of 142 patients, 65% of whom were injecting drug users.

Results:  Thirty-six episodes of meningitis were diagnosed in 33 patients (23%). Of these, 17 cases (47%) were tuberculous meningitis (5 definite and 12 probable) and 7 (19%) corresponded to cryptococcal meningitis. Comparative studies of the tuberculous and cryptococcal meningitis cases showed injecting drug use as the most common form of HIV transmission in the tuberculous meningitis (P=.03) and a lower mean CD4+ cell count in the cryptococcal meningitis group (P=.02).

Conclusions:  Tuberculous meningitis was the prime type of meningitis, which was associated with HIV transmission by injecting drug use. Cryptococcal meningitis appears in more advanced stages of HIV infection, which determines its characteristic presentation.

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