Challenges of diagnosis and management of tuberculosis and HIV coinfection in resource-limited settings: a case report from Lima, Peru

J Int Assoc Physicians AIDS Care (Chic). 2008 Sep-Oct;7(5):232-7. doi: 10.1177/1545109708325468. Epub 2008 Sep 23.

Abstract

We present a Peruvian human immunodeficiency virus (HIV)-positive patient receiving first-line therapy for tuberculosis who presents with neurological complications to highlight some of the major issues in the diagnosis and management of human immunodeficiency virus-related central nervous system complications in resource-poor settings. These include limited options for diagnosing extrapulmonary and drug-resistant tuberculosis; the importance of central nervous system . imaging; and the management conundrum when faced with a broad differential diagnosis. This patient was with drug-resistant tuberculosis of the brain, unmasked by immunologic recovery in the setting of recent initiation of antiretroviral treatment. We argue that aggressive and timely empiric multidrug-resistant tuberculosis treatment is important in cases where drug-resistant tuberculosis is suspected. Knowledge gaps include a limited understanding of immune reconstitution and the optimal timing of antiretroviral treatment in the setting of drug-resistant tuberculosis.

Publication types

  • Case Reports

MeSH terms

  • AIDS-Related Opportunistic Infections* / diagnosis
  • AIDS-Related Opportunistic Infections* / drug therapy
  • AIDS-Related Opportunistic Infections* / microbiology
  • Adult
  • Anti-HIV Agents / therapeutic use
  • Antitubercular Agents / therapeutic use
  • Brain Diseases* / complications
  • Brain Diseases* / diagnosis
  • Brain Diseases* / drug therapy
  • Brain Diseases* / microbiology
  • HIV Infections* / complications
  • HIV Infections* / diagnosis
  • HIV Infections* / drug therapy
  • HIV Infections* / virology
  • Humans
  • Immune Reconstitution Inflammatory Syndrome
  • Magnetic Resonance Imaging
  • Male
  • Mycobacterium tuberculosis / isolation & purification
  • Peru
  • Poverty
  • Tomography, X-Ray Computed
  • Tuberculosis, Central Nervous System* / complications
  • Tuberculosis, Central Nervous System* / diagnosis
  • Tuberculosis, Central Nervous System* / drug therapy
  • Tuberculosis, Central Nervous System* / microbiology
  • Tuberculosis, Cutaneous* / complications
  • Tuberculosis, Cutaneous* / diagnosis
  • Tuberculosis, Cutaneous* / microbiology
  • Tuberculosis, Multidrug-Resistant / complications*
  • Tuberculosis, Multidrug-Resistant / diagnosis
  • Tuberculosis, Multidrug-Resistant / drug therapy
  • Tuberculosis, Multidrug-Resistant / microbiology
  • Urban Health

Substances

  • Anti-HIV Agents
  • Antitubercular Agents