title: Clinical features, Outcomes and Molecular Profiles of Drug Resistance in Tuberculous Meningitis in non-HIV Patients.
abstract: Tuberculous meningitis continues to be a serious problem for physicians because it is difficult to make an early diagnosis and the consequences of delaying treatment are severe. The objective of this study is to provide data for the optimization of diagnostic and timely treatment of tuberculous meningitis. Of the 401 human immunodeficiency virus (HIV)-negative tuberculous meningitis patients in our study, 332 were found to have an impaired blood brain barrier (82.8%). Nearly 17.0% of patients failed to be timely diagnosed. Headache (53.6%) and fever (48.6%) were the most common features, and Computed Tomography/Magnetic Resonance Imaging (CT/MRI) detected 96 patients (23.9%) with abnormal meningeal imaging. Cerebrospinal fluid real-time polymerase chain reaction was positive in 73.8% of the tuberculous meningitis patients, whereas, smears and cultures detected only 6.7% and 5.2%, respectively. Further analysis identified striking differences between drug-resistant and drug-susceptible tuberculous meningitis. Patients with drug resistance correlated with grave prognosis. Tuberculous meningitis diagnosis should overall embody clinical symptoms, laboratory and cerebral imaging findings, and more sensitive diagnostic approaches are still warranted. Our data suggest cerebrospinal fluid polymerase chain reaction for mycobacterial DNA and molecular drug susceptibility testing as routine assays for suspected tuberculous meningitis patients, and observation of the blood brain barrier function could be performed for individual management.
authors.affiliation: Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, P.R China.
authors.forename: Jingya
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, P.R China.
authors.forename: Xuejiao
authors.initials: X
authors.lastname: Hu
authors.affiliation: Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, P.R China.
authors.forename: Xin
authors.initials: X
authors.lastname: Hu
authors.affiliation: Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, P.R China.
authors.forename: Yuanxin
authors.initials: Y
authors.lastname: Ye
authors.affiliation: Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, P.R China.
authors.forename: Mengqiao
authors.initials: M
authors.lastname: Shang
authors.affiliation: Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, P.R China.
authors.forename: Yunfei
authors.initials: Y
authors.lastname: An
authors.affiliation: Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, P.R China.
authors.forename: Haimei
authors.initials: H
authors.lastname: Gou
authors.affiliation: Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, P.R China.
authors.forename: Zhenzhen
authors.initials: Z
authors.lastname: Zhao
authors.affiliation: Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, P.R China.
authors.forename: Wu
authors.initials: W
authors.lastname: Peng
authors.affiliation: Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, P.R China.
authors.forename: Xingbo
authors.initials: X
authors.lastname: Song
authors.affiliation: Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, P.R China.
authors.forename: Yanhong
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, P.R China.
authors.forename: Mei
authors.initials: M
authors.lastname: Kang
authors.affiliation: Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, P.R China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Xie
authors.affiliation: Division of Pulmonary Disease, Department of Respiratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, P.R China.
authors.forename: Xuerong
authors.initials: X
authors.lastname: Chen
authors.affiliation: Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, P.R China.
authors.forename: Xiaojun
authors.initials: X
authors.lastname: Lu
authors.affiliation: Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, P.R China.
authors.forename: Binwu
authors.initials: B
authors.lastname: Ying
authors.affiliation: Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, P.R China.
authors.forename: Lanlan
authors.initials: L
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000494:pharmacology*; D002648:Child; D002681:China / Q000453:epidemiology; D024881:Drug Resistance, Bacterial; D005260:Female; D005838:Genotype; D018023:HIV Seronegativity; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000235:genetics*; D063868:Patient Outcome Assessment; D015995:Prevalence; D011379:Prognosis; D014390:Tuberculosis, Meningeal / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents