This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Peter D. Friedmann, MD, MPH; Matthew H. Samore, MD; Kevin L. Kraemer, MD, MS; David R. Calkins, MD, MPP

Arch Intern Med. 1995;155(20):2231-2237.

Abstract
Background
Neurologic complaints are common in adults infected with the human immunodeficiency virus, but little is known about which clinical features are associated with secondary causes of meningitis.

Methods
A retrospective cross-sectional study of adults infected with the human immunodeficiency virus who received a diagnostic lumbar puncture (LP) in the infectious disease clinic, emergency department, and inpatient wards of the Deaconess Hospital, Boston, Mass, from 1989 through 1992 to determine which clinical features available at the time of LP are correlated with definite or probable secondary meningitis.

Results
Of the 491 LPs, 90% were performed in whites, 93% in men, and 11% in injection drug users. Cerebrospinal fluid test results revealed secondary meningitis in 39 (7.9%) of 491 LPs performed on 322 individuals. Cryptococcal meningitis was the predominant type (27 cases); no bacterial or tuberculous meningitis was found. In multivariate analyses, a history of non-Hodgkin's lymphoma (adjusted odds ratio [OR], 4.3; 95% confidence interval [CI], 1.5 to 12.5), a history of herpes simplex virus infection (OR, 2.5; 95% CI, 1.2 to 5.0), nausea and/ or vomiting (OR, 2.0; 95% CI, 1.03 to 4.0), headache in a person with the acquired immunodeficiency syndrome (OR, 2.1; 95% CI, 1.03 to 4.4), and cranial nerve abnormalities (OR, 5.1; 95% CI, 1.8 to 14.1) were positive correlates of opportunistic meningitis; current fluconazole use (OR, 0.3; 95% CI, 0.1 to 0.8) conferred a lower risk.

Conclusion
In similar clinical settings, physicians and their human immunodeficiency virus—infected patients should consider these features when assessing the risk of secondary meningitis and the necessity for immediate LP.

(Arch Intern Med. 1995;155:2231-2237)

Author Affiliations
From the Divisions of General Internal Medicine (Drs Friedmann, Kraemer, and Calkins) and Infectious Diseases (Dr Samore), Department of Medicine, Deaconess Hospital and Harvard Medical School, Boston, Mass. Dr Friedmann is now with the Section of General Internal Medicine, Department of Medicine, the Pritzker School of Medicine, University of Chicago (Ill).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?