CD4 count in Tuberculous Meningitis patients with HIV co-infection. - A perfect surrogate marker of disease severity?

Dr Ram S Kaulgud,Mallikarjuna Swamy,Harshavardhan Reddy,Kumar N M

doi:10.7439/ijbr.v4i10.380

Abstract

Introduction: Tubercular meningitis is frequently associated with HIV infection. There have been no markers identified till today which can indicate severity of Tubercular meningitis. Aim : To test correlation between clinical severity grading and mortality of HIV patients suffering from tubercular meningitis with and to identify surrogate markers of severity of tubercular meningitis. Material and Methods: We carried out retrospective analysis of the data from the clinical records of HIV infected patients with a diagnosis of TBM admitted between June 2010 to Dec 2012. The neurologic status of patients was classified according to the BMRC staging system. Correlation between clinical staging, laboratory parameters was analysed. Results: Of the 44 cases included in the study 35(79%) were male, 11(21%) were female patients. Thirty two patients (72%) of 44 patients were using antiretroviral drugs at the time of admission. CD4 count was found to correlate with the mortality in the study group. But other factors like age or sex of the patient, patients hemoglobin or total leucocyte count, and also CSF protein, sugar or cell count- were not found to correlate with the clinical severity grading or mortality. Conclusion: Only CD4 cell counts correlate with clinical severity grading and mortality of patients with HIV infection suffering from tubercular meningitis.

Highlights

Tubercular meningitis is frequently associated with Human Immunodeficiency Virus (HIV) infection
Only CD4 cell counts correlate with clinical severity grading and mortality of patients with HIV infection suffering from tubercular meningitis
HIV infected patients are at increased risk for tuberculous meningitis, but HIV infection does not alter the clinical manifestations, cerebrospinal fluid (CSF) findings and response to therapy,[4,5] CSF examination may frequently be normal in HIV seropositive subjects with TBM

Summary

Introduction

Tubercular meningitis is frequently associated with HIV infection. There have been no markers identified till today which can indicate severity of Tubercular meningitis. Tuberculosis is the most common opportunistic infection in patients with Human immunodeficiency virus.[1] Neurological tuberculosis can sometimes be the initial presentation of HIV.[2] Tuberculous meningitis is the most severe clinical presentation of tuberculosis and cause high mortality and morbidity, in HIV infected individuals in developing countries.[3] HIV infected patients are at increased risk for tuberculous meningitis, but HIV infection does not alter the clinical manifestations, CSF findings and response to therapy,[4,5] CSF examination may frequently be normal in HIV seropositive subjects with TBM In such patients radiological clues to the diagnoses of TBM include cisternal enhancement, multiloculated abscesses, communicating hydrocephalus and basal ganglia infarction, which are not the findings associated with CNS lymphoma or toxoplasma encephalitis. The early diagnosis of TBM continues to be difficult; lack of sensitivity of acid-fast bacilli staining and nucleic acid-based amplification and www.ssjournals.com delayed results of cultures make clinical and cerebrospinal fluid abnormalities ideal way to determine the initiation of empirical treatment.[3,6]

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