Influence of HIV co-infection on clinical presentation and disease outcome in hospitalized adults with tuberculous meningitis in Brazil: a nationwide observational study
IntroductionTuberculous meningitis (TBM) is a severe form of central nervous system infection caused by Mycobacterium tuberculosis (Mtb) that is often associated with significant morbidity and mortality, particularly in people living with HIV (PLWH). This study investigated differences in clinical a...
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Frontiers Media S.A.
2025-06-01
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| author | Lucas G. Urmenyi Lucas G. Urmenyi Lucas G. Urmenyi Caian L. Vinhaes Caian L. Vinhaes Caian L. Vinhaes Klauss Villalva-Serra Klauss Villalva-Serra Klauss Villalva-Serra Klauss Villalva-Serra Mariana Araujo-Pereira Mariana Araujo-Pereira Mariana Araujo-Pereira Bruno B. Andrade Bruno B. Andrade Bruno B. Andrade Bruno B. Andrade |
| author_facet | Lucas G. Urmenyi Lucas G. Urmenyi Lucas G. Urmenyi Caian L. Vinhaes Caian L. Vinhaes Caian L. Vinhaes Klauss Villalva-Serra Klauss Villalva-Serra Klauss Villalva-Serra Klauss Villalva-Serra Mariana Araujo-Pereira Mariana Araujo-Pereira Mariana Araujo-Pereira Bruno B. Andrade Bruno B. Andrade Bruno B. Andrade Bruno B. Andrade |
| author_sort | Lucas G. Urmenyi |
| collection | DOAJ |
| description | IntroductionTuberculous meningitis (TBM) is a severe form of central nervous system infection caused by Mycobacterium tuberculosis (Mtb) that is often associated with significant morbidity and mortality, particularly in people living with HIV (PLWH). This study investigated differences in clinical and laboratory profiles of TBM cases in Brazil associated with HIV status, and identified factors associated with in-hospital mortality.MethodsWe conducted a retrospective analysis of 1,819 hospitalized adult TBM patients reported in the Brazilian Notifiable Diseases Information System (SINAN) meningitis database from 2007 to 2021. Confirmed cases in hospitalized individuals aged >18 years with known HIV status were included; pregnant patients were excluded. Clinical and laboratory features were compared by HIV status and clinical outcomes. Classification and regression tree analysis was used to identify outcome-based cut-off values for selected continuous variables. Associations with in-hospital mortality were assessed using backward stepwise binomial logistic regressions.ResultsThe majority (57%) of TBM cases comprised of PLWH, who exhibited lower frequencies of vomiting, nuchal rigidity, signs of meningeal inflammation, and coma, along with lower leukocyte counts in cerebrospinal fluid (CSF) compared to HIV-negative patients. PLWH also displayed lower mortality rates (17.3% vs. 23.2%, p = 0.002). Features independently associated with mortality included seizures (aOR: 2.15, 95%CI: 1.39–3.33, p < 0.001), nuchal rigidity (aOR: 1.57, 95%CI: 1.1–2.23, p = 0.014), age > 64 years old (aOR: 2.11, 95%CI: 1.08–4.13, p = 0.03), CSF protein concentration ≥441 mg/dL (aOR: 2:08, 95%CI: 1.39–3.09, p < 0.001) and CSF glucose concentration ≥ 22 mg/dL (aOR: 0.54, 95%CI: 0.38–0.76, p < 0.001), but not HIV (OR: 0.73, [95%IC: 0.52–1.01], p = 0.06).ConclusionOur findings suggest that despite greater prevalence in PLWH, these patients present fewer clinical signs and symptoms and lower mortality rates. Additionally, HIV was not an independent predictor of mortality in this study population. |
| format | Article |
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| institution | DOAJ |
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| language | English |
| publishDate | 2025-06-01 |
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| series | Frontiers in Public Health |
| spelling | doaj-art-610826d3a69c42179e86b7cd1058d2002025-08-20T03:20:12ZengFrontiers Media S.A.Frontiers in Public Health2296-25652025-06-011310.3389/fpubh.2025.16001041600104Influence of HIV co-infection on clinical presentation and disease outcome in hospitalized adults with tuberculous meningitis in Brazil: a nationwide observational studyLucas G. Urmenyi0Lucas G. Urmenyi1Lucas G. Urmenyi2Caian L. Vinhaes3Caian L. Vinhaes4Caian L. Vinhaes5Klauss Villalva-Serra6Klauss Villalva-Serra7Klauss Villalva-Serra8Klauss Villalva-Serra9Mariana Araujo-Pereira10Mariana Araujo-Pereira11Mariana Araujo-Pereira12Bruno B. Andrade13Bruno B. Andrade14Bruno B. Andrade15Bruno B. Andrade16Curso de Medicina, Universidade Salvador, Salvador, BrazilMultinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, BrazilInstituto de Pesquisa Clínica e Translacional, Faculdade Zarns, Clariens Educação, Salvador, BrazilMultinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, BrazilLaboratório de Pesquisa Clínica e Translacional, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, BrazilDepartamento de Infectologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, BrazilCurso de Medicina, Universidade Salvador, Salvador, BrazilMultinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, BrazilInstituto de Pesquisa Clínica e Translacional, Faculdade Zarns, Clariens Educação, Salvador, BrazilLaboratório de Pesquisa Clínica e Translacional, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, BrazilMultinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, BrazilInstituto de Pesquisa Clínica e Translacional, Faculdade Zarns, Clariens Educação, Salvador, BrazilLaboratório de Pesquisa Clínica e Translacional, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, BrazilCurso de Medicina, Universidade Salvador, Salvador, BrazilMultinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, BrazilInstituto de Pesquisa Clínica e Translacional, Faculdade Zarns, Clariens Educação, Salvador, BrazilLaboratório de Pesquisa Clínica e Translacional, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, BrazilIntroductionTuberculous meningitis (TBM) is a severe form of central nervous system infection caused by Mycobacterium tuberculosis (Mtb) that is often associated with significant morbidity and mortality, particularly in people living with HIV (PLWH). This study investigated differences in clinical and laboratory profiles of TBM cases in Brazil associated with HIV status, and identified factors associated with in-hospital mortality.MethodsWe conducted a retrospective analysis of 1,819 hospitalized adult TBM patients reported in the Brazilian Notifiable Diseases Information System (SINAN) meningitis database from 2007 to 2021. Confirmed cases in hospitalized individuals aged >18 years with known HIV status were included; pregnant patients were excluded. Clinical and laboratory features were compared by HIV status and clinical outcomes. Classification and regression tree analysis was used to identify outcome-based cut-off values for selected continuous variables. Associations with in-hospital mortality were assessed using backward stepwise binomial logistic regressions.ResultsThe majority (57%) of TBM cases comprised of PLWH, who exhibited lower frequencies of vomiting, nuchal rigidity, signs of meningeal inflammation, and coma, along with lower leukocyte counts in cerebrospinal fluid (CSF) compared to HIV-negative patients. PLWH also displayed lower mortality rates (17.3% vs. 23.2%, p = 0.002). Features independently associated with mortality included seizures (aOR: 2.15, 95%CI: 1.39–3.33, p < 0.001), nuchal rigidity (aOR: 1.57, 95%CI: 1.1–2.23, p = 0.014), age > 64 years old (aOR: 2.11, 95%CI: 1.08–4.13, p = 0.03), CSF protein concentration ≥441 mg/dL (aOR: 2:08, 95%CI: 1.39–3.09, p < 0.001) and CSF glucose concentration ≥ 22 mg/dL (aOR: 0.54, 95%CI: 0.38–0.76, p < 0.001), but not HIV (OR: 0.73, [95%IC: 0.52–1.01], p = 0.06).ConclusionOur findings suggest that despite greater prevalence in PLWH, these patients present fewer clinical signs and symptoms and lower mortality rates. Additionally, HIV was not an independent predictor of mortality in this study population.https://www.frontiersin.org/articles/10.3389/fpubh.2025.1600104/fulltuberculous meningitisHIVclinical presentationrisk factorsBrazil |
| spellingShingle | Lucas G. Urmenyi Lucas G. Urmenyi Lucas G. Urmenyi Caian L. Vinhaes Caian L. Vinhaes Caian L. Vinhaes Klauss Villalva-Serra Klauss Villalva-Serra Klauss Villalva-Serra Klauss Villalva-Serra Mariana Araujo-Pereira Mariana Araujo-Pereira Mariana Araujo-Pereira Bruno B. Andrade Bruno B. Andrade Bruno B. Andrade Bruno B. Andrade Influence of HIV co-infection on clinical presentation and disease outcome in hospitalized adults with tuberculous meningitis in Brazil: a nationwide observational study Frontiers in Public Health tuberculous meningitis HIV clinical presentation risk factors Brazil |
| title | Influence of HIV co-infection on clinical presentation and disease outcome in hospitalized adults with tuberculous meningitis in Brazil: a nationwide observational study |
| title_full | Influence of HIV co-infection on clinical presentation and disease outcome in hospitalized adults with tuberculous meningitis in Brazil: a nationwide observational study |
| title_fullStr | Influence of HIV co-infection on clinical presentation and disease outcome in hospitalized adults with tuberculous meningitis in Brazil: a nationwide observational study |
| title_full_unstemmed | Influence of HIV co-infection on clinical presentation and disease outcome in hospitalized adults with tuberculous meningitis in Brazil: a nationwide observational study |
| title_short | Influence of HIV co-infection on clinical presentation and disease outcome in hospitalized adults with tuberculous meningitis in Brazil: a nationwide observational study |
| title_sort | influence of hiv co infection on clinical presentation and disease outcome in hospitalized adults with tuberculous meningitis in brazil a nationwide observational study |
| topic | tuberculous meningitis HIV clinical presentation risk factors Brazil |
| url | https://www.frontiersin.org/articles/10.3389/fpubh.2025.1600104/full |
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