Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/inmunología , Seropositividad para VIH/inmunología , Malaria Falciparum/inmunología , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Adolescente , Adulto , Animales , Anticuerpos Antiprotozoarios/análisis , Western Blotting , Brasil/epidemiología , Reacciones Cruzadas , Ensayo de Inmunoadsorción Enzimática/métodos , Femenino , Anticuerpos Anti-VIH/análisis , Seropositividad para VIH/diagnóstico , Seropositividad para VIH/epidemiología , Humanos , Malaria Falciparum/diagnóstico , Malaria Falciparum/epidemiología , Masculino , Persona de Mediana Edad , Plasmodium falciparum/inmunología , Reacción en Cadena de la Polimerasa/métodosRESUMEN
A meningite neutrofílica persistente é raramente diagnosticada e é caracterizada pelo predomínio neutrofílico na contagem diferencial do número de leucócitos nas amostras de líquido cefalorraquidiano retiradas após sete dias de tratamento adequado. O paciente aqui descrito é soropositivo para o HIV, apresentou febre e confusão mental durante 4 meses e pleocitose neutrofílica na análise liquórica por mais 5 meses. Foi tratado desde o início com tuberculostáticos. Durante três meses as reações imunológicas, as culturas e as pesquisas diretas foram negativas. No sexagésimo dia de internação, a pesquisa de bacilo álcool-ácido resistente (BAAR) no líquor foi positiva e a cultura confirmou a presença de Mycobacterium tuberculosis resistente à isoniazida. Vários fatores podem provocar esta evolução incomum. O comprometimento da imunidade celular, principalmente na liberação de citocinas pró-inflamatórias como a IL 8 e o FNT. O uso concomitante de medicações que poderiam alterar a concentração liquórica dos tuberculostáticos e o aparecimento crescente de cepas multirresistentes foram discutidos.
Persistent neutrophilic meningitis is rarely found and it is characterized by predominance of the number of neutrophils in samples of C SF (cerebrospinal fluid) from the patient after seven days of treatment. The above patient in HIV positive; he has developed fever and mental disorder for 4 months and has presented neutrophilic pleocytosis in analysis of CSF for more than 5 months. Since the beginning or the treatment he has taken antituberculous drugs and corticosteroids. For 3 months, the serologic evaluation, smears and cultures were negative. On the 60th day in hospital, the investigation of acid-fast bacilli in CSF was positive and culture confirmed the presence of Mycobacterium tuberculosis resistant to isoniazid. Several factors that may have caused this uncommon development were discussed: the disturbance of cell-mediated immunity, mainly in release of IL 8 and TNF, the simultaneous use of medicines that could alter the CSF concentration of antituberculous drugs, and the increasing number of multiresistant strains.
Asunto(s)
Humanos , Masculino , Adulto , VIH-1 , Meningitis/diagnóstico , Neutrófilos , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Abuso de Sustancias por Vía Intravenosa/complicaciones , Resultado Fatal , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Líquido Cefalorraquídeo/citología , Meningitis/líquido cefalorraquídeo , Síndrome de Inmunodeficiencia Adquirida/líquido cefalorraquídeo , Factores de Tiempo , Tuberculosis Meníngea/diagnósticoRESUMEN
Persistent neutrophilic meningitis is rarely found and it is characterized by predominance of the number of neutrophils in samples of C SF (cerebrospinal fluid) from the patient after seven days of treatment. The above patient in HIV positive; he has developed fever and mental disorder for 4 months and has presented neutrophilic pleocytosis in analysis of CSF for more than 5 months. Since the beginning or the treatment he has taken antituberculous drugs and corticosteroids. For 3 months, the serologic evaluation, smears and cultures were negative. On the 60th day in hospital, the investigation of acid-fast bacilli in CSF was positive and culture confirmed the presence of Mycobacterium tuberculosis resistant to isoniazid. Several factors that may have caused this uncommon development were discussed: the disturbance of cell-mediated immunity, mainly in release of IL 8 and TNF, the simultaneous use of medicines that could alter the CSF concentration of antituberculous drugs, and the increasing number of multiresistant strains.