**1. Introduction**

[81] Harris, R. J, & Kavuru, M. S. Mehta ACThe impact of thoracoscopy on the manage‐

[82] Blumberg, H. M, Burman, W. J, Chaisson, R. E, et al. American Thoracic Society/ Centers for Disease Control and Prevention / Infectious Disease Society of America:

[83] Lee, C. H, & Wang, C. J. Lan RS Corticosteroids in the treatment of tuberculous pleurisy: a double-blind, placebo-controlled, randomised study Chest (1988). , 94,

[84] Wyser, C, & Walzl, G. Smedema JP Corticosteroids in the treatment of tuberculous pleurisy: a double-blind, placebo-controlled, randomised study. Chest (1996). , 110,

[85] Galarza, I, Canete, C, & Granados, A. Randomised trial of corticosteroids in the treat‐

[86] Chung, C. L, Chen, C. L, Yeh, C. Y, et al. Early effective drainage in the treatment of

[87] Pablo de AVillena V., Echave-Sustaeta L., Encuentra AL Are pleural fluid parameters related to the development of residual pleural thickening in tuberculosis? Chest

[88] Iuchi K, Aozasa K, Yamamoto S et al. Non-Hodgkin´s lymphoma of the pleural cavi‐ ty developing from longstanding pyothorax. Summary of clinical and pathological

ment of tuberculous pleurisy Thorax (1999). , 50, 1305-1307.

loculated tuberculous pleurisy Eur Respir J (2008). , 31, 1261-1267.

findings in thirty-seven cases Jpn J Clin Oncol (1989) 19(3):249-57

treatment of tuberculosis Am J Respir Crit Care Med (2003). , 167, 603-662.

ment of pleural disease Chest (1996). , 107, 845-852.

292 Tuberculosis - Current Issues in Diagnosis and Management

1256-1259.

333-338.

(1997). , 112, 1293-1297.

The incidence and mortality of tuberculosis (TB), the most common opportunistic infection in HIV patients has drastically increased with the emergence of the HIV pandemic

The HIV infection supported the re-emergence of TB as well as two major changes in the natural history of TB, namely it has increased the frequency of extrapulmonary TB and the mycobac‐ terial multidrug resistance. The extrapulmonary TB involvement is present in up to 40% of the HIV cases and includes respiratory, digestive, lymphatic and neurologic localizations. Of these neurotuberculosis (NTB) is probably the most devastating extrapulmonary form of TB. The risk of acquiring NTB in HIV patients has been reported as 10 times higher than in non-HIV individuals and its related mortality exceeds 50%. The prognosis is further worsened by the HIV related progressive immunodeficiency which leads to the reactivation of opportunistic infections and the development of malignancies. The early diagnosis of NTB in HIV positive patients improves the short and long term prognosis of these patients and increases their life expectancy. Unfortunately the complexity of the clinical presentation and the variability of the bacteriological results accounts for significant difficulties in the diagnostic confirmation of NTB. Therefore treatment in these patients is often empirical. Moreover the antituberculous treatment is of long duration with serious adverse effects. Ensuing complications during treatment include the immune reconstitution inflammatory syndrome (IRIS) - a complication that is characteristic for HIV patients undergoing treatment for TB. Furthermore the multiple drug interactions between the antituberculous and antiretroviral treatment require close supervision of these patients.

This chapter summarizes the epidemiological, pathogenic, clinic and therapeutic challenges of NTB in HIV patients.

This chapter summarizes the epidemiological, pathogenic, clinic and therapeutic challenges of NTB in HIV patients.

© 2013 Iacob and Iacob; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2013 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
