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Free Content Molecular analysis of Mycobacterium tuberculosis causing multidrug-resistant tuberculosis meningitis

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Abstract:

SETTING: Tertiary referral hospitals in southern Vietnam.

OBJECTIVE: Molecular characterisation of multidrug-resistant (MDR) tuberculous meningitis (TBM).

DESIGN: Mycobacterium tuberculosis isolates from the cerebrospinal fluid (CSF) of 198 Vietnamese adults were compared with 237 isolates from patients with pulmonary tuberculosis (PTB) matched for age, sex and residential district. Isolates resistant to isoniazid or rifampicin (RMP) were sequenced in the rpoB and katG genes, inhA promoter and oxyR-ahpC intergenic regions.

RESULTS: While drug resistance rates were lower in the CSF (2.5% MDR) than pulmonary isolates (5.9% MDR), the difference was not significant. The most commonly mutated codons were 531, 526 and 516 in rpoB and 315 in katG. Four novel triple mutants in rpoB were identified.

CONCLUSION: RMP resistance is a good surrogate marker for MDR-TBM in this setting. However, probes directed against these three codons would have a maximum sensitivity of only 65%. A rapid phenotypic detection test may be more applicable for the diagnosis of MDR-TBM.

Keywords: Vietnam; meningitis; multidrug-resistant; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam; and Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, Oxford, UK 2: Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam; and Brighton and Sussex University Hospital, Department of Infectious Diseases and Microbiology, Brighton, Sussex, UK 3: Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam 4: Pham Ngoc Thach Hospital for Tuberculosis and Lung Diseases, Ho Chi Minh City, Vietnam 5: Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, Oxford, UK 6: The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam 7: Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, Oxford, UK; and Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand

Publication date: February 1, 2007

More about this publication?
  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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