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- Title
Effect of Antituberculosis Drug Resistance on Response to Treatment and Outcome in Adults with Tuberculous Meningitis.
- Authors
Thwaites, Guy E.; Nguyen Thi Ngoc Ian; Nguyen Huy Dung; Hoang Thi Quy; Do Thi Tuong Oanh; Nguyen Thi Cam Thoa; Nguyen Quang Hien; Nguyen Tri Thuc; Nguyen Ngoc Hai; Nguyen Duc Bang; Nguyen Ngoc Ian; Nguyen Hong Duc; Vu Ngoc Tuan; Cao Huu Hiep; Tran Thi Hong Chau; Pham Phuong Mai; Nguyen Thi Dung; Stepniewska, Kasia; White, Nicholas J.; Iran Tinh Hien
- Abstract
Background. Tuberculous meningitis (TBM) caused by Myco bacterium tuberculosis resistant to 1 or more antituberculosis drugs is an increasingly common clinical problem, although the impact on outcome is uncertain. Methods. We performed a prospective study of 180 Vietnamese adults admitted consecutively for TBM. M. tuberculosis was cultured from the cerebrospinal fluid (CSF) of all patients and was tested for susceptibility to first-line antituberculosis drugs. Presenting clinical features, time to CSF bacterial clearance, clinical response to treatment, and 9-month morbidity and mortality were compared between adults infected with susceptible and those infected with drug-resistant organisms. Results. Of 180 isolates, 72 (40.0%) were resistant to at least 1 antituberculosis drug, and 10 (5.6%) were resistant to at least isoniazid and rifampicin. Isoniazid and/or streptomycin resistance was associated with slower CSF bacterial clearance but not with any differences in clinical response or outcome. Combined isoniazid and rifampicin resistance was strongly predictive of death (relative risk of death, 11.63 [95% confidence interval, 5.21- 26.32]) and was independently associated with human immunodeficiency virus infection. Conclusions. Isoniazid and/or streptomycin resistance probably has no detrimental effect on the outcome of TBM when patients are treated with first-line antituberculosis drugs, but combined isoniazid and rifampicin resistance is strongly predictive of death.
- Subjects
ANTITUBERCULAR agents; DRUG therapy for tuberculosis; MENINGITIS; CENTRAL nervous system diseases; CEREBROSPINAL fluid; BODY fluids
- Publication
Journal of Infectious Diseases, 2005, Vol 192, Issue 1, p79
- ISSN
0022-1899
- Publication type
Article
- DOI
10.1086/430616