Monocyte to Lymphocyte Ratio in Peripheral Blood of Tuberculous Meningitis with HIV Patients in Tertiary Hospital in West Java

Ridha Amalia, Dewi Kartika Turbawaty, Adhi Kristianto Sugianli, Siti Aminah


ObjectiveTo describe peripheral blood monocyte to lymphocyte (ML) ratio in tuberculous meningitis (TBM) patients with human immunodeficiency virus (HIV) infection in Dr. Hasan Sadikin General Hospital Bandung as a tertiary hospital in West Java Province, Indonesia.

Method: A cross-sectional study with retrospective data approach was done in Dr. Hasan Sadikin General Hospital, Bandung. Data were collected from TBM patients who were hospitalized in Dr. Hasan Sadikin General Hospital, Bandung in the period of 2014–2016. The sample size was determined using total sampling method. General data, clinical manifestation data, and laboratory finding data were collected. The ML ratio was collected and presented into three groups of percentile (25th, 25–75th and 75th) based on the pre-defined cut-off.

Result: Six subjects (40%) had an ML ratio of ≤0.47 and 3 subjects had an ML ratio of ≥1.22 in TBM with HIV population. Among TBM with HIV-negative population, there were 16 subjects had ML ratio ≤0.47, and 19 subjects had ML ratio ≥1.22.

Conclusion: The ML ratio in TBM with HIV infection has become additional tool for detecting the development of TBM with HIV-infected, as well as TBM with non-HIV-infected. Therefore, it could help directing the patients with clinical suspicious of TBM into the diagnosis algorithm and treatment of TBM, to have better outcome.

Keywords: Human immunodeficiency virus infection,lymphocyte, monocyte, monocyte to lymphocyte ratio, tuberculous meningitis


DOI: 10.15850/ijihs.v6n1.1140


Human immunodeficiency virus infection,lymphocyte, monocyte, monocyte to lymphocyte ratio, tuberculous meningitis

Full Text:



World Health Organization | HIV/AIDS Fact Sheets. 2016.[cited 2017 Aug 17]. Available from:

Walker NF, Meintjes G, Wilkinson RJ. HIV-1 and the immune response to TB. Future Virol. 2013;8(1):57–80.

Vinnard C, Macgregor RR. Tuberculous meningitis in HIV-infected individuals. Curr HIV/AIDS Rep. 2009;6(3):139–45.

Ghosh GC, Sharma B, Gupta BB. CSF ADA determination in early diagnosis of tuberculous meningitis in HIV-infected patients. Scientifica [serial on the internet]. 2016 Apr [cited 2017 Jun 10];2016(1):[about 4p.]. Available from:

Veltman JA, Bristow CC, Klausner JD. Review article meningitis in HIV-positive patients in sub-Saharan Africa: a review. J Int AIDS Soc. 2014;17(1):1–10.

Isabel BE, Rogelio HP. Pathogenesis and immune response in tuberculous meningitis. Malays J Med Sci. 2014;21(1):4–10.

Marais S, Thwaites G, Schoeman JF, Török ME, Misra UK, Prasad K, et al. Tuberculous meningitis: a uniform case definition for use in clinical research. Lancet Infect Dis. 2010;10(11):803–12.

Török ME. Tuberculous meningitis: advances in diagnosis and treatment. Br Med Bull. 2015;113(1):117–31.

Wang J, Yin Y, Wang X, Pei H, Kuai S, Gu L. Ratio of monocytes to lymphocytes in peripheral blood in patients diagnosed with active tuberculosis. Braz J Infect Dis. 2015;19(2):125–31.

Naranbhai V, Hill AVS, Abdool Karim SS, Naidoo K, Abdool Karim Q, Warimwe GM, et al. Ratio of monocytes to lymphocytes in peripheral blood identifies adults at risk of incident tuberculosis among HIV-infected adults initiating antiretroviral therapy. J Infect Dis. 2014;209(4):500–9.

Iqbal S, Ahmed U, Khan MA. Haematological parameters altered in tuberculosis. Pak J Physiol. 2015;11(1):13–6.

Afriandi I, Aditama TY, Mustikawati D, Oktavia M, Alisjahbana B, Riono P. HIV and injecting drug use in Indonesia: epidemiology and national response. Acta Med Indones. 2009;41(1):75–8.

Agarwal A, Bhat MS, Kumar A, Shaharyar A, Mishra M, Yadav R. Lymphocyte/monocyte ratio in osteoarticular tuberculosis in children: a haematological biomarker revisited. Trop Doct. 2016;46(2):73–7.

Tobin DM, Roca FJ, Oh SF, McFarland R, Vickery TW, Ray JP, et al. Host genotype-specific therapies can optimize the inflammatory response to mycobacterial infections. Cell. 2012;148(3):434–46.

Baldridge MT, King KY, Boles NC, Weksberg DC, Goodell MA. Quiescent haematopoietic stem cells are activated by IFN-γ in response to chronic infection. Nature. 2010;465(7299):793–7.

Schroeder T. Hematopoietic stem cell heterogeneity: subtypes, not unpredictable behavior. Cell Stem Cell. 2010;6(3):203–7.

Muller-Sieburg CE, Sieburg HB, Bernitz JM, Cattarossi G. Stem cell heterogeneity: Implications for aging and regenerative medicine. Blood. 2012;119(17):3900–7.

Okamura K, Nagata N, Wakamatsu K, Yonemoto K, Ikegame S, Kajiki A, et al. Hypoalbuminemia and lymphocytopenia are predictive risk factors for in-hospital mortality in patients with tuberculosis. Intern Med. 2013;52(4):439–44.

Muller GL, Davidson DL. The monocyte-lymphocyte ratio as ameasurement of activity in pulmonary tuberculosis. N Engl J Med. 1934;211(6):248–52

Iqbal S, Ahmed U, Badshah S, Zaidi H. Monocyte lymphocyte ratio as a possible prognostic marker in antituberculous therapy. JRawal Med College. 2014;18(2):178–81.


Article Metrics

Abstract view : 631 times
PDF - 256 times


This Journal indexed by



Creative Commons License
IJIHS is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License

View My Stats