Clinical features and diagnosis of tuberculous meningoencephalitis in patients infected with human immunodeficiency virus
The results of a prospective study of 66 patients aged 32,6±3,8 years infected with the human immunodeficiency virus who were treated in an anti-tuberculosis medical organization for tuberculosis meningoencephalitis are presented. Of these, 49 (74,2%) were newly diagnosed with tuberculosis, and 17 (25,8%) had relapses and chronic forms of tuberculosis. According to social characteristics, patients were distributed as follows: working - 9 (13,6%), non-working - 57 (86,4%), disabled people with tuberculosis - 4 (6,1%), persons who previously served their sentences in prison - 48 (72,7%). All the surveyed patients had bad habits: they continued to actively use psychoactive substances - 52 (78,8%) people, abused alcohol - 43 (65,2%), smoked - 60 (90,1%). In 97% of cases, tuberculosis of the meninges and Central nervous system was a complication of respiratory tuberculosis: tuberculosis of the intra-thoracic lymph nodes - 42,4%, disseminated pulmonary tuberculosis - 27,3%, infiltrative pulmonary tuberculosis - 22,7%, and caseous pneumonia- 7,6%. The most effective method for diagnosing the tuberculosis etiology of meningoencephalitis in patients infected with the human immunodeficiency virus is the study of cerebrospinal fluid using a polymerase chain reaction. Deoxyribonucleic acid of Mycobacterium tuberculosis was detected in 31 (47%) patients. The characteristics of the cerebrospinal fluid in the examined patients are presented as follows: a decrease in glucose in 45 (68,2%) patients, an increase in protein in 59 (89,4%), and cytosis at the upper limit of normal values in 10 (15,6%). High mortality rates (47,7%) in patients infected with the human immunodeficiency virus in combination with tuberculosis meningoencephalitis are associated with a high degree of immunosuppression.