IngentaConnect Familial outbreak of disseminated multidrug-resistant tuberculosi...

Authors: Sofia M.¹; Maniscalco M.¹; Honoré N.²; Molino A.¹; Mormile M.¹; Heym B.²; Cole S. T.²

Source: The International Journal of Tuberculosis and Lung Disease, Volume 5, Number 6, June 2001 , pp. 551-558(8)

Publisher: International Union Against Tuberculosis and Lung Disease

Abstract:

Rapidly progressive multidrug-resistant tuberculosis (MDR-TB) is well documented in human immunodeficiency virus (HIV) positive subjects, but it is not fully recognised in HIV-negative subjects in the familial environment. We report three cases of MDR-TB in three young HIV-negative subjects from the same family. All the patients showed signs of meningitis during the course of their disease, and in two cases a resistant strain of Mycobacterium tuberculosis was isolated in cerebrospinal fluid. Two of the three subjects died from neurological complications; the other was successful treated utilising both systemic and intrathecal therapy for tuberculous meningitis. By a retrospective analysis of DNA obtained from Löwenstein-Jensen cultures, the strains were confirmed as M. tuberculosis resistant to rifampicin and isoniazid, and were closely related in the two cases where specimens were available for analysis. The resistance was acquired in two patients initially infected with a susceptible strain; in the other patient, the resistance was present on the first sensitivity test for which results were available. This report demonstrates the high risk of fatality from MDR-TB for HIV-negative subjects in the absence of reliable early diagnostic and preventive tools. It also reinforces the concept that genetic susceptibility to M. tuberculosis may be an important factor in the clinical presentation and outcome of MDR-TB.

Keywords: multidrug-resistant tuberculosis; tuberculous meningitis; tuberculosis

Language: English

Document Type: Regular paper

Affiliations: 1: Department of Respiratory Disease, University of Naples ‘Federico II’, AOMonaldi, Naples, Italy 2: Unite de Génétique Moléculaire Bactérienne, Institut Pasteur, Paris, France

Familial outbreak of disseminated multidrug-resistant tuberculosis and meningitis