title: High rate of drug resistance among tuberculous meningitis cases in Shaanxi province, China.
abstract: The clinical and mycobacterial features of tuberculous meningitis (TBM) cases in China are not well described; especially in western provinces with poor tuberculosis control. We prospectively enrolled patients in whom TBM was considered in Shaanxi Province, northwestern China, over a 2-year period (September 2010 to December 2012). Cerebrospinal fluid specimens were cultured for Mycobacterium tuberculosis; with phenotypic and genotypic drug susceptibility testing (DST), as well as genotyping of all positive cultures. Among 350 patients included in the study, 27 (7.7%) had culture-confirmed TBM; 84 (24.0%) had probable and 239 (68.3%) had possible TBM. DST was performed on 25/27 (92.3%) culture positive specimens; 12/25 (48.0%) had "any resistance" detected and 3 (12.0%) were multi-drug resistant (MDR). Demographic and clinical features of drug resistant and drug susceptible TBM cases were similar. Beijing was the most common genotype (20/25; 80.0%) with 9/20 (45%) of the Beijing strains exhibiting drug resistance; including all 3 MDR strains. All (4/4) isoniazid resistant strains had mutations in the katG gene; 75% (3/4) of strains with phenotypic rifampicin resistance had mutations in the rpoB gene detected by Xpert MTB/RIF®. High rates of drug resistance were found among culture-confirmed TBM cases; most were Beijing strains.
authors.affiliation: Department of Neurology, Xijing Hospital, the Fourth Military Medical University, no.169 Changle West Road, Xi'an, Shaanxi, 710032, P.R.China.|Department of Neurology, Kunming Medical University affiliated Yan'an Hospital, 245 Renming East Road, Kunming, Yunnan, 650200, P.R.China.
authors.forename: Ting
authors.initials: T
authors.lastname: Wang
authors.affiliation: Department of Neurology, Xijing Hospital, the Fourth Military Medical University, no.169 Changle West Road, Xi'an, Shaanxi, 710032, P.R.China.
authors.forename: Guo-Dong
authors.initials: GD
authors.lastname: Feng
authors.affiliation: National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, no.155 Changbai Road, Beijing, 102206, P.R.China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Pang
authors.affiliation: Department of Inspection, Xijing Hospital, Fourth Military Medical University, no.169 Changle West Road, Xi'an, Shaanxi, 710032, P.R.China.
authors.forename: Jia-Yun
authors.initials: JY
authors.lastname: Liu
authors.affiliation: National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, no.155 Changbai Road, Beijing, 102206, P.R.China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Department of Neurology, Xijing Hospital, the Fourth Military Medical University, no.169 Changle West Road, Xi'an, Shaanxi, 710032, P.R.China.
authors.forename: Yi-Ning
authors.initials: YN
authors.lastname: Yang
authors.affiliation: Department of Neurology, Xijing Hospital, the Fourth Military Medical University, no.169 Changle West Road, Xi'an, Shaanxi, 710032, P.R.China.
authors.forename: Wen
authors.initials: W
authors.lastname: Dai
authors.affiliation: Department of Neurology, Xijing Hospital, the Fourth Military Medical University, no.169 Changle West Road, Xi'an, Shaanxi, 710032, P.R.China.
authors.forename: Lin
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Neurology, Xijing Hospital, the Fourth Military Medical University, no.169 Changle West Road, Xi'an, Shaanxi, 710032, P.R.China.
authors.forename: Qiao
authors.initials: Q
authors.lastname: Li
authors.affiliation: Department of Neurology, Xijing Hospital, the Fourth Military Medical University, no.169 Changle West Road, Xi'an, Shaanxi, 710032, P.R.China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Gao
authors.affiliation: Department of Neurology, Xijing Hospital, the Fourth Military Medical University, no.169 Changle West Road, Xi'an, Shaanxi, 710032, P.R.China.
authors.forename: Ping
authors.initials: P
authors.lastname: Chen
authors.affiliation: Department of Neurology, Kunming Medical University affiliated Yan'an Hospital, 245 Renming East Road, Kunming, Yunnan, 650200, P.R.China.
authors.forename: Li-Ping
authors.initials: LP
authors.lastname: Zhan
authors.affiliation: The Children's Hospital at Westmead and the Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Australia.
authors.forename: Ben J
authors.initials: BJ
authors.lastname: Marais
authors.affiliation: National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, no.155 Changbai Road, Beijing, 102206, P.R.China.
authors.forename: Yan-Lin
authors.initials: YL
authors.lastname: Zhao
authors.affiliation: Department of Neurology, Xijing Hospital, the Fourth Military Medical University, no.169 Changle West Road, Xi'an, Shaanxi, 710032, P.R.China.
authors.forename: Gang
authors.initials: G
authors.lastname: Zhao
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001426:Bacterial Proteins / Q000235:genetics; D002374:Catalase / Q000235:genetics; D002555:Cerebrospinal Fluid / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D012321:DNA-Directed RNA Polymerases / Q000235:genetics; D024881:Drug Resistance, Bacterial; D005260:Female; D005838:Genotype; D060005:Genotyping Techniques; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000302:isolation & purification*; D015995:Prevalence; D011446:Prospective Studies; D014390:Tuberculosis, Meningeal / Q000453:epidemiology / Q000382:microbiology*; D055815:Young Adult
chemical_list: D001426:Bacterial Proteins; D002374:Catalase; C480353:katG protein, Mycobacterium tuberculosis; D012321:DNA-Directed RNA Polymerases; C105078:RNA polymerase beta subunit