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Abstract
Meningitis caused by multidrug-resistant strains of Mycobacterium tuberculosis in patients with AIDS
Ambrosioni Czyrko J.1, Cecchini D.1, Brezzo C.1, Corti M.1, Pérez M.2, Ambroggi M.2
Objectives: Tuberculosis (TB) is one of the most frequent opportunistic infections among HIV-infected patients, and meningitis is one of its most severe clinical presentations. Argentina has reported, in the last decade, cases of infection by multidrug-resistant strains of Mycobacterium tuberculosis (MR-TB: defined as resistant, at least, to isoniacid+rifampin). The aim of this study was to analyze epidemiological features, drug resistance profile and clinical outcome of HIV-infected patients with multidrug-resistant tuberculous meningitis.
Methods: Retrospective analysis of clinical charts of HIV-infected patients with MR-TB isolated from cerebrospinal fluid (CSF) attended at the Infectious Diseases “Francisco J. Muñiz” Hospital, Buenos Aires, Argentina (1996-2005). Data were processed with Statistix software.
Results: Of a total of 44 HIV-infected patients with meningitis caused by MR-TB, 59% had concomitant isolation from extraneural samples (most frequent from sputum). The median age was 33 years; 75% were male and 70% had prior or ongoing TB treatment. The median CD4 T cell count was 24 cells/µL (range: 1-238). Two patients had another concomitant AIDS-defining disease (cerebral toxoplasmosis and neurocryptococcosis). The resistance profiles of the isolated strains were: A) Resistant to isoniacid+rifampin: 18.2%; B) Resistant to 3 or 4 drugs (isoniacid+rifampin+pirazinamid+/-etambutol or streptomicin): 59.1%; C) Resistant to 5 or 6 drugs (isoniacid+rifampin+pirazinamid+etambutol+streptomicin +/-kanamicin): 22.7%. Initial empiric treatment was inappropriate for 51% of these patients; it was adjusted by the resistance pattern only in 38%. Global mortality was 79.5%, there was no statistical difference in mortality between patients with strains resistant to isoniacid+rifampin vs. resistant to 3 or more drugs (p>0.05).
Conclusions: Prior or ongoing antituberculous treatment was very frequent in patients with meningitis by MR-TB; efforts need to be made to ensure treatment completion. Mortality was high because of patients advanced HIV disease and the inappropriate initial antituberculous treatment. To our knowledge, this is the biggest series of HIV-infected patients with meningitis by MR-TB.
4th IAS Conference on HIV Pathogenesis, Treatment and Prevention
Abstract no.
MOPEB028
Suggested Citation
"AmbrosioniCzyrkoJ., et al.
Meningitis caused by multidrug-resistant strains of Mycobacterium tuberculosis in patients with AIDS.
Poster exhibition:
4th IAS Conference on HIV Pathogenesis, Treatment and Prevention:
Abstract no.
MOPEB028"
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