Current Neurology and Neuroscience Reports

, Volume 7, Issue 6, pp 470–475

Multidrug-resistant tuberculous meningitis

Article

Abstract

Multidrug-resistant tuberculous meningitis is now appearing worldwide, including in the United States, and is difficult to diagnose and treat. We discuss methods to diagnose tuberculous meningitis, review current and experimental assays for determining drug resistance, and consider approaches to management of the patient. We review the epidemiology of multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis in both pulmonary and meningeal infections, discuss promising molecular methods for determining drug resistance, and review current approaches toward treatment of patients. The incidence of multidrug-resistant tuberculous meningitis is increasing, and diagnosing and treating these patients will be a major challenge. There is a need to improve rapid methods of isolating the organism from cerebrospinal fluid, to advance molecular methods to rapidly test the isolate for antibiotic sensitivity, and to develop new antituberculosis drugs, especially ones that cross the blood-cerebrospinal fluid barrier.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Ormerod LP: Multidrug-resistant tuberculosis (NDR-TB): epidemiology, prevention and treatment. Br Med Bull 2005, 73&74:17–24.CrossRefGoogle Scholar
  2. 2.
    Centers for Disease Control: Trends in tuberculosis incidence—United States, 2006. MMWR Morb Mortal Wkly Rep 2007, 56:245–250.Google Scholar
  3. 3.
    Centers for Disease Control: Notice to readers: revised definition of extensively drug-resistant tuberculosis. MMWR Morb Mortal Wkly Rep 2006, 55:1176.Google Scholar
  4. 4.
    Centers for Disease Control: Emergence of Mycobacterium tuberculosis with extensive resistance to second-line drugs—worldwide, 2000–2004. MMWR Morb Mortal Wkly Rep 2006, 55:301–305.Google Scholar
  5. 5.
    Zignol M, Hosseini MS, Wright A, et al.: Global incidence of multidrug-resistant tuberculosis. J Infect Dis 2006, 194:497–485.CrossRefGoogle Scholar
  6. 6.
    Daley CL, Small PM, Schecter GF, et al.: An outbreak of tuberculosis with accelerated progression among persons infected with the human immunodeficiency virus. An analysis using restriction-fragment-length polymorphisms. N Engl J Med 1992, 326:231–235.PubMedCrossRefGoogle Scholar
  7. 7.
    Goldfield A, Ellner JJ: Pathogenesis and management of HIV/TB co-infection in Asia. Tuberculosis (Edinb) 2007, In press.Google Scholar
  8. 8.
    Fischl MA, Uttamchandani RB, Daikos GL, et al.: An outbreak of tuberculosis caused by multiple-drug resistant tubercle bacilli among patients with HIV infection. Ann Intern Med 1992, 117:177–183.PubMedGoogle Scholar
  9. 9.
    Patel VB, Padayatchi N, Bhigjee AL, et al.: Multidrug-resistant tuberculous meningitis in KwaZulu-Natal, South Africa. Clin Infect Dis 2004, 38:851–856.PubMedCrossRefGoogle Scholar
  10. 10.
    Caws M, Thwaites GE, Duy PM, et al.: Molecular analysis of Mycobacterium tuberculosis causing multidrug-resistant tuberculosis meningitis. Int J Tuberc Lung Dis 2007, 11:202–208.PubMedGoogle Scholar
  11. 11.
    De Vincenzo JP, Berning SE, Peloquin CA, Husson RN: Multidrug-resistant tuberculous meningitis: Clinical problems and concentrations of second-line antituberculous medications. Ann Pharmacother 1999, 33:1184–1188.CrossRefGoogle Scholar
  12. 12.
    Kang PB, Azad AK, Torrelles JB, et al.: The human macrophage mannose receptor directs Mycobacterium tuberculosis lipoarabinomannan-mediated phagosome biogenesis. J Exp Med 2005, 202:987–999.PubMedCrossRefGoogle Scholar
  13. 13.
    Ming T, Chakravarty S, Zhu G, et al.: Characterization of the tuberculous granuloma in murine and human lungs: cellular composition and relative oxygen tension. Cell Micro 2006, 8:218–232.CrossRefGoogle Scholar
  14. 14.
    Park H, Guinn KM, Harrell MI, et al.: Rv3133c/dosR is a transcription factor that mediates the hypoxic response of Mycobacterium tuberculosis. Mol Microbiol 2003, 48:833–843.PubMedCrossRefGoogle Scholar
  15. 15.
    Porkert MT, Sotir M, Parrott-Moore P, Blumberg HM: Tuberculous meningitis at a large inner city medical center. Am J Med Sci 1997, 313:325–331.PubMedCrossRefGoogle Scholar
  16. 16.
    Girgis NL, Farid SZ, Mansour M, et al.: Tuberculous meningitis, Abbassia Fever Hospital — Naval medical research unit no. 3 — Cairo, Egypt, from 1976–1996. Am J Trop Hygiene 1998, 58:28–34.Google Scholar
  17. 17.
    Ciesielski SD: BCG vaccination and the PPD test: what the clinician needs to know. J Fam Pract 1995, 40:76–80.PubMedGoogle Scholar
  18. 18.
    Merritt HH, Fremont-Smith F: Cerebrospinal fluid in tuberculous meningitis. Arch Neurol Psychiatr 1933, 33:516–536.Google Scholar
  19. 19.
    Davis LE, Rastogi KR, Lambert LC, Skipper BJ: Tuberculous meningitis in the southwest United States. Neurology 1993, 43:1775–1778.PubMedGoogle Scholar
  20. 20.
    Gupta RK, Gupta S, Singh D, et al.: MR imaging and angiography in tuberculous meningitis. Neuroradiology 1984, 36:87–92.CrossRefGoogle Scholar
  21. 21.
    Srikanth SG, Taly AB, Nagarajan K, et al.: Clinicoradiological features of tuberculous meningitis in patients over 50 years of age. J Neurol Neurosurg Psychiatr 2007, 78:536–538.PubMedCrossRefGoogle Scholar
  22. 22.
    Schoeman JF, Van Zyl LE, Laubscher JA, Donald PR: Effect of corticosteroids on intracranial pressure, computed tomographic findings, and clinical outcome in young children with tuberculous meningitis. Pediatrics 1997, 99:226–231.PubMedCrossRefGoogle Scholar
  23. 23.
    Davis LE: Subacute and chronic meningitis. Continuum 2006, 12:27–57.Google Scholar
  24. 24.
    Pfyffer GE, Kissling P, Jahn EM, et al.: Diagnostic performance of amplified Mycobacterium tuberculosis direct test with cerebrospinal fluid, other nonrespiratory, and respiratory specimens. J Clin Microbiol 1996, 34:834–841.PubMedGoogle Scholar
  25. 25.
    Kennedy DH, Fallon RJ: Tuberculous meningitis. J Am Med Assoc 1979, 241:264–268.CrossRefGoogle Scholar
  26. 26.
    Zhao JR, Bai YJ, Wang Y, et al.: Development of pyrosequencing approach for rapid screening of rifampin, isoniazid and ethambutol-resistant Mycobacterium tuberculosis. Int J Tuberc Lung Dis 2005, 9:328–332.PubMedGoogle Scholar
  27. 27.
    Kox LF, Kuijper S, Kolk AH: Early diagnosis of tuberculous meningitis by polymerase chain reaction. Neurology 1995, 45:2228–2232.PubMedGoogle Scholar
  28. 28.
    Kruuner A, Yates MD, Drobniewski FA: Evaluation of MGIT 960-based antimicrobial testing and determination of critical concentrations of first-and second-line antimicrobial drugs with drug-resistant clinical strains of Mycobacterium tuberculosis. J Clin Microbiol 2006, 44:811–817.PubMedCrossRefGoogle Scholar
  29. 29.
    Tenover FC: Rapid detection and identification of bacterial pathogens using novel molecular technologies: infection control and beyond. Clin Infect Dis 2007, 44:418–423.PubMedCrossRefGoogle Scholar
  30. 30.
    Thwaites GE, Lan N, Dung N, et al.: Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults. N Engl J Med 2004, 351:1741–1751.PubMedCrossRefGoogle Scholar
  31. 31.
    Iseman MD: Treatment of multidrug-resistant tuberculosis. N Engl J Med 1993, 329:784–791.PubMedCrossRefGoogle Scholar
  32. 32.
    Thwaites GE, Lan N, Dung N, et al.: Effect of antituberculosis drug resistance on response to treatment and outcome in adults with tuberculous meningitis. J Infect Dis 2005, 192:79–88.PubMedCrossRefGoogle Scholar
  33. 33.
    Dorman SE, Chaisson RE: From magic bullets back to the magic mountain: the rise of extensively drug-resistant tuberculosis. Nat Med 2007, 13:295–298.PubMedCrossRefGoogle Scholar
  34. 34.
    World Health Organization: Guidelines for the programmatic management of drug-resistant tuberculosis. 2006. Available at http://www.who.int/tb. Accessed July 1, 2007.
  35. 35.
    Caminero JA: Treatment of multidrug-resistant tuberculosis: evidence and controversies. Int J Tuberc Lung Dis 2006, 10:829–837.PubMedGoogle Scholar
  36. 36.
    Mukherjee JS, Rich ML, Socci AR, et al.: Programmes and principles in treatment of multidrug-resistant tuberculosis. Lancet 2004, 363:474–481.PubMedCrossRefGoogle Scholar
  37. 37.
    Furin J: The clinical management of drug-resistant tuberculosis. Curr Opin Pulm Med 2007, 13:212–217.PubMedCrossRefGoogle Scholar
  38. 38.
    Raviglione MC, Smith IM: XDR tuberculosis—implications for global public health. N Engl J Med 2007, 356:656–659.PubMedCrossRefGoogle Scholar
  39. 39.
    Shah N, Wright A, Bai G, et al.: Worldwide emergence of extensively drug-resistant tuberculosis. Emerg Infect Dis 2007, 13:380–387.PubMedCrossRefGoogle Scholar
  40. 40.
    Nuermberger E, Rosenthal I, Tyagi S, et al.: Combination chemotherapy with the nitroimidazopyran PA-824 and first-line drugs in a murine model of tuberculosis. Antimicrob Agents Chemother 2006, 50:2621–2625.PubMedCrossRefGoogle Scholar
  41. 41.
    Andries K, Verhasselt P, Guillemont J, et al.: A diaryquinoline drug active on the ATP synthase of Mycobacterium tuberculosis. Science 2005, 307:223–227.PubMedCrossRefGoogle Scholar
  42. 42.
    du Toit LC, Pillay V, Danckwerts MP: Tuberculosis chemotherapy: current drug delivery approaches. Respir Res 2006, 7:118–136.PubMedCrossRefGoogle Scholar
  43. 43.
    Lamprecht D, Schoeman J, Donald P, Hartzenberg H: Ventriculoperitoneal shunting in childhood tuberculosis meningitis. Br J Neurosurg 2001, 15:119–125.PubMedCrossRefGoogle Scholar
  44. 44.
    Kent SJ, Crowe SM: Tuberculous meningitis: a 30 year review. Clin Infect Dis 1993, 17:987–994PubMedGoogle Scholar
  45. 45.
    Kalita J, Misra UK, Ranjan P: Predictors of long-term neurological sequelae of tuberculous meningitis: a multivariate analysis. Eur J Neurol 2007, 14:33–37.PubMedCrossRefGoogle Scholar
  46. 46.
    Dube MP, Holtom PD, Larsen RA: Tuberculous meningitis in patients with and without human immunodeficiency virus infection. Am J Med 1992, 93:520–524.PubMedCrossRefGoogle Scholar

Copyright information

© Current Medicine Group LLC 2007

Authors and Affiliations

  1. 1.Department of MedicineNew Mexico Veterans Affairs Health Care SystemAlbuquerqueUSA

Personalised recommendations