[Tuberculous meningitis caused by resistant microorganisms. Therapeuticfailure in 2 patients with HIV infection and disseminated tuberculosis].
BACKGROUND
Tuberculosis in HIV infected patients does not carry a worse therapeutic response rate. Treatment failure is usually due to incomplete schedule, with development of acquired resistance. Two patients with HIV infection and disseminated tuberculosis who developed fatal meningitis are presented.


METHODS
In vitro studies of sensitivity to anti-tuberculous drugs were carried out, using the proportions method.


RESULTS
Following a good initial evolution, both patients were readmitted with tuberculous meningitis resistant to isoniazide in both and to rifampicin in one of the patients. In one patient, the original strain (which was sensitive) was available. In this patient, changes in the treatment were performed in the initial phase.


CONCLUSIONS
The importance of anti-tuberculous multiple therapy, particularly in the initial phases, for HIV positive patients is crucial. The lengthen of admission when good patient's compliance is in question, but also to avoid, whenever possible, changes in treatment are important measures in this stage. Meningitis may occur as a form of therapeutic failure and its cure may be difficult if the strains are resistant.
Sección de Enfermedades Infecciosas, Hospital Ramón y Cajal, Madrid.
J
J
Fortún
E
E
Gómez-Mampaso
E
E
Navas
J M
JM
Hermida
A
A
Antela
A
A
Guerrero
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000382:microbiology*; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D004352:Drug Resistance, Microbial; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D017809:Fatal Outcome; D006801:Humans; D007538:Isoniazid / Q000494:pharmacology / Q000627:therapeutic use; D008297:Male; D009169:Mycobacterium tuberculosis / Q000187:drug effects; D011718:Pyrazinamide / Q000627:therapeutic use; D012293:Rifampin / Q000494:pharmacology / Q000627:therapeutic use; D013307:Streptomycin / Q000627:therapeutic use; D014390:Tuberculosis, Meningeal / Q000188:drug therapy / Q000382:microbiology*; D015215:Zidovudine / Q000627:therapeutic use
D000995:Antitubercular Agents; D011718:Pyrazinamide; D015215:Zidovudine; D007538:Isoniazid; D012293:Rifampin; D013307:Streptomycin
Meningitis tuberculosa por microorganismos resistentes. Fracaso terapéutico en 2 pacientes con infección por HIV y tuberculosis diseminada.