Abstract
BACKGROUND Tuberculosis is the most frequent infectious disease causing death worldwide. The main risk factor is an HIV infection. CNS involvement occurs in 5 - 20 % of HIV infected patients with tuberculosis. MATERIAL AND METHODS We investigated all cases of CNS tuberculosis in HIV infection treated in a German university hospital from 1998 to 2006. Clinical symptoms, differential diagnosis, diagnostic and therapeutic standards of cerebral tuberculosis, including specific aspects in HIV infection, are discussed. RESULTS The incidence of CNS tuberculosis in HIV infected patients was 1.5 %. All patients were transiently treated in an ICU. Related to all HIV infected patients admitted to an ICU, the incidence of CNS tuberculosis was 10 %. CONCLUSIONS Tuberculosis is an important differential diagnosis in HIV infected patients with focal and diffuse brain lesions. Due to the HIV associated immunodeficiency syndrome, atypical diagnostic results are seen frequently. Extensive diagnostic investigations should be performed, including biopsy and search for extra cerebral manifestation. An antituberculous treatment is indicated even in cases suspicious of cerebral tuberculosis. HAART reduces the mortality risk significantly.
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