Journal of Integrated Health Sciences

: 2020  |  Volume : 8  |  Issue : 1  |  Page : 51-

An unusual/varied presentation of two cases of tuberculous meningitis

Mahmood Dhahir Al-Mendalawi 
 Department of Paediatrics, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq

Correspondence Address:
Prof. Mahmood Dhahir Al-Mendalawi
P. O. Box 55302, Baghdad Post Office, Baghdad

How to cite this article:
Al-Mendalawi MD. An unusual/varied presentation of two cases of tuberculous meningitis.J Integr Health Sci 2020;8:51-51

How to cite this URL:
Al-Mendalawi MD. An unusual/varied presentation of two cases of tuberculous meningitis. J Integr Health Sci [serial online] 2020 [cited 2020 Aug 8 ];8:51-51
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Dear Sir,

In July–December 2019 issue of the Journal of Integrated Health Sciences, Shah et al.[1] nicely described atypical presentation of tuberculous meningitis (TBM) in two Indian patients. It is explicit that the advent of human immunodeficiency virus (HIV) has greatly contributed to the increase in the number of patients with tuberculosis (TB). The clinical picture of TB/HIV co-infection depends on the integrity of immune status. Truly, HIV-associated TB has an atypical clinical, radiological, and biological presentation as well as more frequent extrapulmonary dissemination. The severity tends to be more when there is a significant immune deficiency.[2],[3] In India, HIV infection is a worrying health problem. The available published data showed that the national adult seroprevalence of HIV was estimated at 0.22% (0.16%–0.30%) in 2017.[4] Additionally, the prevalence of HIV/TB co-infection among Indian patients with HIV has been estimated to be significant (12.3%), and 56% of TB lesions in such patients were noticed to be extrapulmonary.[5] It has been suggested that all TB patients in India must be assessed for HIV risk factors and counseled to undergo HIV testing while all HIV-positive patients must be screened for TB.[5] I assume that HIV infection ought to be critically considered in the two cases in question. Regrettably, Shah et al.[1] did not consider HIV infection as the diagnostic set employed in the studied two patients did not recruit HIV testing. Therefore, the diagnostic set for HIV detection in terms of CD4 lymphocyte count and viral overload measurements would have envisaged. If that set was to show HIV reactivity, the two cases in question could be surely regarded novel case reports of atypical presentation of TBM.

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1Shah MP, Lakhani JD, Patel KS, Vaswani VN. An unusual/varied presentation of two cases of tuberculous meningitis. J Integr Health Sci 2019;7:69-72.
2Kouassi B, N'Gom A, Horo K, Godé C, Ahui B, Emvoudou NM, et al. Correlation of the manifestations of tuberculosis and the degree of immunosuppression in patients with HIV. Rev Mal Respir 2013;30:549-54.
3Saleeb PG, Buchwald UK. Update on the epidemiology, diagnosis and therapy of tuberculosis in HIV-infected patients. Pneumologie 2014;68:666-75.
4Government of India, Ministry of Health & Family Welfare, National AIDS Control Organization. HIV Facts & Figures. Available from: [Last accessed on 2020 Feb 25].
5Manjareeka M, Nanda S. Prevalence of HIV infection among tuberculosis patients in Eastern India. J Infect Public Health 2013;6:358-62.