Clinical and Diagnostic Characteristics of Tuberculosis Meningoencephalitis among Patients with HIV Infection

Tuberculosis (TB) is the most frequent opportunistic infection among HIV-positive patients in all countries of the world. The spread of the TB/HIV epidemic is an objective threat on a national scale and continues to negatively affect the working and reproductive potentials of the population of many countries of the world. Objective — to analyze the clinical and diagnostic manifestations of tuberculous meningoencephalitis in patients with HIV infection. Materials and methods. We analyzed the medical data of patients who were in hospital for a specific process at the Lviv Regional Anti-TB Center from 2020 to 2023. 31 medical records of patients with TB of the central nervous system (CNS) against the background of HIV infection were selected. General clinical, microscopic, molecular genetic, cultural, morphological studies, linear probe analysis and X-ray instru­mental examinations were carried out according to current standards. Results and discussion. The analysis of the structure of a specific lesion of the CNS found that in 97 % of cases the clinical form of HIV-positive was TB meningoencephalitis, which in 86 % was combined with lesions of other organs (lungs, different groups of lymph nodes (LN)). Axillary and mesenteric LN lesions were most often diagnosed, and 57.1 % of cases revealed a different combination of several groups of peripheral LNs. TB brain damage was more often diagnosed in HIV-positive men, city residents, of working age. In most patients (80.6 %) a specific process was detected for the first time, in addition, chemoresistant forms were diagnosed in 13 % of cases. It is important that two patients admitted in a state of moderate severity noted a deterioration in their general condition over the past 6 months, however, they did not seek medical help, and in 29 % of cases the specific process lasted from 2 to 3 months, which contributed to the generalization of TB infection in various organs, the development of complications in 16.7 %, as well as prolonged inpatient treatment and reduction/loss of ability to work of every second HIV-infected patient. In 45.2 % of cases TB agent was detected in the cerebrospinal fluid and/or sputum using the method GeneXpert MTB/Rif. Concomitant pathology was in 80.7 % of cases, almost every second observed diseases of eyes, gastrointestinal tract and hematopoietic system. The most common radiological signs of respiratory lesions in HIV-positive with TB meningoencephalitis were focal shadows of mild and moderate intensity, sometimes of a confluent nature, increased pulmonary pattern or its deformation due to intersti­tial, peribronchial changes, fibrosis elements, or a combination of these changes, half of the patients had non-structural roots. Conclusions. It is necessary to implement active, targeted diagnostic, treatment and preventive measu­res for TB/HIV co-infection, for the implementation of which it is necessary to update information and deep knowledge of specialists at different levels of medical care.