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CORRESPONDENCE
Year : 2016  |  Volume : 34  |  Issue : 2  |  Page : 255
 

Multi-drug resistant tuberculous meningitis


P.D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India

Date of Submission17-Apr-2015
Date of Acceptance02-Sep-2015
Date of Web Publication14-Apr-2016

Correspondence Address:
Camilla Rodrigues
P.D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0255-0857.180365

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How to cite this article:
Kambli P, Nikam C, Shetty A, Soman R, Rodrigues C. Multi-drug resistant tuberculous meningitis. Indian J Med Microbiol 2016;34:255

How to cite this URL:
Kambli P, Nikam C, Shetty A, Soman R, Rodrigues C. Multi-drug resistant tuberculous meningitis. Indian J Med Microbiol [serial online] 2016 [cited 2019 Jun 20];34:255. Available from: http://www.ijmm.org/text.asp?2016/34/2/255/180365


Dear Editor,

Childhood tuberculous meningitis (TBM) even today has a poor outcome despite treatment. Poor prognosis and difficult early diagnosis emphasize the importance of preventive therapy for child contacts of patients with tuberculosis (TB) with a low threshold for empirical treatment of TBM suspects. [1] Though TBM affects only 1% of all cases of TB, it is still the most serious form with high mortality or severe disability. Therefore, clinicians have to begin to treat without the knowledge of susceptibility of the organism, which is increasingly being compromised. In 2014, we noted a 13% (63/205) increase in overall TB cerebrospinal fluid (CSF) culture positivity as compared to the similar period in 2013 (53/308). There are not many published reports of drug susceptibility testing (DST) in TBM. [2]

At our accredited tertiary care center laboratory, we analyzed the culture positive CSF samples those were received from January 2014 to June 2014. Of the 205 CSF samples processed during this period by TB Mycobacteria Growth Indicator Tubes (MGIT) culture (Becton Dickinson Diagnostic System, Sparks, MD), 63 were culture positive for Mycobacterium tuberculosis (MTB) complex giving a positivity rate of 30.73%. Of these, 24 samples were from children between the ages of 1 and 15 years (38%). Thirty-five isolates that included 14 from children were found to be multi-drug resistant (MDR) by DST performed for rifampicin (RIF) and isoniazid (INH) by MGIT 960. Twenty-six of the 35 were additionally confirmed by genotype MTB DR plus (Hain Life science, Nehren, Germany). Of the 17 deaths, nine were children with MDR-TB. We recognize that this may not be representative of the community at large, as ours is a center with a referral bias. Hence, we have not calculated the rates or attempted to assess the prevalence of MDR-TB in TBM. It must be emphasized that INH with its excellent CSF penetration and early bactericidal activity is an important drug for TBM. Hence, mono resistance to INH is of great consequence. However, there was a lower mono resistance with 3/63 isolates being RIF resistant and 6/63 being INH resistant. In an earlier study on TBM, resistance to at least one anti-TB drug (40%) with MDR rates of 5.6% was found. [3] We maintain that CSF TB cultures and DST simply must be attempted in every suspected case of TBM at the first CSF examination, and this should be done prior to initiation of anti tubercular treatment. These results are vital, as they help in fine tuning treatment. Distinguishing paradoxical response and vasculitis, from disease progression due to drug resistance is an important issue. Knowledge of drug susceptibility will be of great help in resolving this clinical problem.

Acknowledgment

We thank the National Health and Education Society, P.D. Hinduja National Hospital and Medical Research Centre.

Financial support and sponsorship

National Health and Education Society, P.D. Hinduja National Hospital and Medical Research Centre.

Conflicts of interest

There are no conflicts of interest.

 
 ~ References Top

1.
Chiang SS, Khan FA, Milstein MB, Tolman AW, Benedetti A, Starke JR, et al. Treatment outcomes of childhood tuberculous meningitis: A systematic review and meta-analysis. Lancet Infect Dis 2014;14:947-57.  Back to cited text no. 1
    
2.
Nagarathna S, Rafi W, Veenakumari HB, Mani R, Satishchandra P, Chandramuki A. Drug susceptibility profiling of tuberculous meningitis. Int J Tuberc Lung Dis 2008;12:105-7.  Back to cited text no. 2
    
3.
Thwaites GE, Lan NT, Dung NH, Quy HT, Oanh DT, Thoa NT, et al. Effect of antituberculosis drug resistance on response to treatment and outcome in adults with tuberculous meningitis. J Infect Dis 2005;192:79-88.  Back to cited text no. 3
    




 

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