patients with tuberculosis without the syndrome, only 56 had extrapulmonary tuberculosis (p less than 0.001). Tuberculosis preceded the syndrome by 1 to 17 months (mean, 6) in 22 patients. In 10 patients with the syndrome and positive sputum cultures who were treated with conventional antituberculosis drugs, the cultures became negative within 1 to 4 months and tuberculosis did not recur. The frequency of disseminated atypical mycobacteriosis or positive sputum cultures for atypical mycobacteria was not significantly different between Haitian (11.3%) and non-Haitian (8.3%) patients with the syndrome.20:T4da,Central nervous system tuberculosis occurred in three patients with the acquired immunodeficiency syndrome (AIDS) and seven patients with AIDS-related complex who were evaluated for 48 months. Nine patients were intravenous drug abusers and one was Haitian. Five patients had cerebral-ring-enhancing lesions and three had hypodense areas. The clinical spectrum included meningitis in two patients, multiple cerebral abscesses in one, and tuberculomas in four. All Mycobacterium tuberculosis isolates were sensitive to standard antituberculous drugs. All patients received treatment with isoniazid, rifampin, and pyrazinamide; six patients also received streptomycin. Three patients with AIDS died of opportunistic infection preceded by central nervous system tuberculosis. Among the patients with the AIDS-related complex, three improved with treatment, three were lost to follow-up, and one died. Tuberculosis should be considered in the differential diagnosis of central nervous system mass lesions in intravenous drug abusers with AIDS or AIDS-related complex. Because patients with tuberculosis can be cured, biopsy of accessible brain mass lesions should be mandatory. Preventive therapy may be indicated in drug abusers without disease.21:T527,Forty-five cases of tuberculous meningitis at a large urban medical center were reviewed. Reasons for the continued incidence, prognostic factors, and current therapy of this life-threatening form of tuberculosis were examined. Thirty-nine of 45 patients were black, Hispanic, and/or 65 years of age or older (87%). Underlying conditions included alcohol abuse in 12, intravenous drug abuse in 7, recent steroid therapy in 4, head trauma in 4, recent pregnancy in 4, and the acquired immunodeficiency syndrome in 1. Thirty-four patients (76%) presented with altered mental status and/or focal neurologic findings. Significant mortality (31%) occurred despite the administration of antituberculous therapy to all but 1 patient. Six of 14 deaths (43%) occurred in the first week of hospitalization. One-third of survivors had neurologic sequelae at the time of follow-up. Neurologic deficits on admission, advanced age, and alcohol abuse were frequent among those who succumbed. Early recognition and treatment in hospital failed to improve outcome in advanced cases. From these findings we conclude that both aggressive treatment of primary tuberculous infections as well as prevention of secondary cases are necessary to effect any further reduction in the incidence, morbidity, and mortality of tuberculous meningitis.22:T448,INFECTIOUS diseases of the central nervous system among immunocompromised patients are not uncommon but rarely involve more than one pathogen.¹Mycobacterium tuberculosisis an infrequent cause of central nervous system infection among immunocompromised patients.^2,3When seen, meningitis is by far the most common presentation. Occurrence of a tuberculous brain abscess is rare.^4-8 Toxoplasmaencephalitis has been recognized as one of the more common central nervous system infections among patients with the acquired immunodeficiency syndrome (AIDS). Concomitant infections, although uncommon, may be an emerging problem. The present report summarizes our experience with a patient who had a tuberculous brain abscess and concomitantToxoplasmaencephalitis.

Report of a Case

A 22-year-old Haitian woman was admitted to the hospital with a nin

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Abstract

References