Isoniazid resistance, mycobacterial genotype and outcome in Vietnamese adults with tuberculous meningitis
Abstract:SETTING: Centre for Tropical Diseases, a 500-bed hospital for infectious diseases in Ho Chi Minh City, Vietnam.
OBJECTIVE: The factors that determine outcome in adults with tuberculous meningitis are poorly understood. The objective of the study was to investigate the relationship between admission clinical features, HIV infection, drug resistance, mycobacterial genotype and outcome in adults with tuberculous meningitis.
DESIGN: Clinical and laboratory data were recorded prospectively for 56 Vietnamese adults with tuberculous meningitis confirmed by culture of cerebrospinal fluid. Variables associated with in-hospital mortality, HIV infection, drug resistance and microbial genotype were assessed by univariate and multivariate analysis.
RESULTS: Admission coma score independently predicted death in hospital (OR 0.73, 95%CI 0.61–0.87, P = 0.001). HIV-infected adults with tuberculous meningitis were more likely to be infected with Mycobacterium tuberculosis resistant to isoniazid (P = 0.011) and streptomycin (P = 0.002). Isoniazid resistance, streptomycin resistance, HIV infection and microbial genotype were not associated with increased in-hospital mortality.
CONCLUSION: Treatment of tuberculous meningitis before the onset of coma saves lives. Resistance to isoniazid and/or streptomycin does not appear to affect outcome.
Document Type: Regular Paper
Affiliations: 1: Nuffield Department of Clinical Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK; and University of Oxford-Wellcome Trust Clinical Research Unit, Ho Chi Minh City, Vietnam 2: Centre for Tropical Diseases, Ho Chi Minh City, Vietnam 3: PHLS Mycobacterium Reference Unit, East Dulwich Grove, London, UK 4: Nuffield Department of Clinical Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK; and Wellcome Trust Clinical Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
Publication date: October 1, 2002
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