Pathophysiology and Prognosis in Vietnamese Adults with Tuberculous Meningitis

Guy E. Thwaites, Cameron P. Simmons, Nguyen Than Ha Quyen, Tran Thi Hong Chau, Pham Phuong Mai, Nguyen Thi Dung, Nguyen Hoan Phu, Nicholas P. White, Tran Tinh Hien, Jeremy J. Farrar

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    The pathogenesis of tuberculous meningitis remains unclear, and there are few data describing the kinetics of the immune response during the course of its treatment. We measured concentrations of pro- and anti-inflammatory cytokines in serial blood and cerebrospinal fluid (CSF) samples from 21 adults who were being treated for tuberculous meningitis. CSF concentrations of soluble tumor necrosis factor-α receptors and of matrix metalloprotein-9 and its tissue inhibitor were also measured, and blood-brain barrier permeability was assessed by the albumin and IgG partition indices. CSF concentrations of lactate, interleukin-8, and interferon-γ were high before treatment and then decreased rapidly with antituberculosis chemotherapy. However, significant immune activation and blood-brain barrier dysfunction were still apparent after 60 days of treatment. Death was associated with high initial CSF concentrations of lactate, low numbers of white blood cells, in particular neutrophils, and low CSF glucose levels.

    Original languageEnglish
    Pages (from-to)1105-1115
    Number of pages11
    JournalThe Journal of Infectious Diseases
    Issue number8
    Publication statusPublished - 15 Oct 2003

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