TUBERCULOUS MENINGITIS - CLINICAL CHARACTERISTICS AND COMPARISON WITHCRYPTOCOCCAL MENINGITIS IN PATIENTS WITH HUMAN-IMMUNODEFICIENCY-VIRUSINFECTION

Objective: To determine the prevalence and causes of meningitis in pat ients with human immunodeficiency virus (HIV) infection. Design: A pro spective study of HIV-associated neurologic complications carried out from 1988 to 1992. Setting: A tertiary care university hospital in Mad rid, Spain. Patients: A total of 142 patients, 65% of whom were inject ing drug users. Results: Thirty-six episodes of meningitis were diagno sed in 33 patients (23%). Of these, 17 cases (47%) were tuberculous me ningitis (5 definite and 12 probable) and 7 (19%) corresponded to cryp tococcal meningitis. Comparative studies of the tuberculous and crypto coccal meningitis cases showed injecting drug use as the most common f orm of HIV transmission in the tuberculous meningitis (P=.03) and a lo wer mean CD4(+) cell count in the cryptococcal meningitis group (P=.02 ). Conclusions: Tuberculous meningitis was the prime type of meningiti s, which was associated with HIV transmission by injecting drug use. C ryptococcal meningitis appears in more advanced stages of HIV infectio n, which determines its characteristic presentation.