title: Drug-resistant tuberculous meningitis.
abstract: Drug-resistant tuberculosis, including drug-resistant tuberculous meningitis, is an emerging health problem in many countries. An association with Beijing strains and drug resistance-related mutations, such as mutations in katG and rpoB genes, has been found. The pathology, clinical features and neuroimaging characteristics of drug-resistant tuberculous meningitis are similar to drug-responsive tuberculous meningitis. Detection of mycobacteria in cerebrospinal fluid (CSF) by conventional methods (smear examination or culture) is often difficult. Nucleic acid amplification assays are better methods owing to their rapidity and high sensitivity. The Xpert MTB/RIF assay (Cepheid, CA, USA) is a fully-automated test that has also been found to be effective for CSF samples. Treatment of multidrug-resistant tuberculous meningitis depends on the drug susceptibility pattern of the isolate and/or the previous treatment history of the patient. Second-line drugs with good penetration of the CSF should be preferred. Isoniazid monoresistant disease requires addition of another drug with better CSF penetration. Drug-resistant tuberculous meningitis is associated with a high mortality. HIV infected patients with drug-resistant tuberculous meningitis have severe clinical manifestations with exceptionally high mortality. Prevention of tuberculosis is the key to reduce drug-resistant tuberculous meningitis.
authors.affiliation: Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India. garg50@yahoo.com
authors.forename: Ravindra K
authors.initials: RK
authors.lastname: Garg
authors.forename: Amita
authors.initials: A
authors.lastname: Jain
authors.forename: Hardeep S
authors.initials: HS
authors.lastname: Malhotra
authors.forename: Avinash
authors.initials: A
authors.lastname: Agrawal
authors.forename: Rajiv
authors.initials: R
authors.lastname: Garg
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use*; D001426:Bacterial Proteins / Q000235:genetics; D002374:Catalase / Q000235:genetics; D002648:Child; D060085:Coinfection; D012321:DNA-Directed RNA Polymerases; D015658:HIV Infections / Q000188:drug therapy; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use*; D009154:Mutation; D009169:Mycobacterium tuberculosis / Q000235:genetics / Q000254:growth & development / Q000302:isolation & purification*; D016019:Survival Analysis; D014390:Tuberculosis, Meningeal / Q000134:cerebrospinal fluid / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D018088:Tuberculosis, Multidrug-Resistant / Q000134:cerebrospinal fluid / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology
chemical_list: D019380:Anti-HIV Agents; D000995:Antitubercular Agents; D001426:Bacterial Proteins; C505805:rpoB protein, Mycobacterium tuberculosis; D002374:Catalase; C480353:katG protein, Mycobacterium tuberculosis; D012321:DNA-Directed RNA Polymerases; D007538:Isoniazid