Features of the course of central nervous system tuberculosis in modern conditions

ABSTRACT. The HIV epidemic in Ukraine leads to an increase in the incidence of extrapulmonary and drug-resistant forms of tuberculosis (TB). One of the most dangerous forms of TB in HIV-infected persons is the generalized form with damage to the central nervous system (CNS). The paper deals with the peculiarities of the course of CNS TB in patients living with HIV infection and in HIV-negative persons. It has been established that in patients with severe immunosuppression, CNS TB is more likely to be atypical: there are no typical clinical signs of CNS TB, no characteristic changes in the cerebrospinal fluid, and the process is often combined with other opportunistic infections. Isolated TB of the brain poses diagnostic difficulties, because in most cases mycobacteria in the cerebrospinal fluid are not detected and there is no way to determine their sensitivity to anti-TB drugs. In this case, treatment is carried out according to standardized regimens, which is not always effective. The prevalence of drug-resistant forms of TB, combination with opportunistic diseases, immunosuppression with CD4 counts <100 cells/μL and late diagnosis lead to high mortality.