Drug Resistance Doesn't Affect Outcome for Vietnamese Tuberculous Meningitis Patients

Researchers in Asia and the United Kingdom have found surprising information about the course of tuberculous meningitis in Vietnamese patients.

Mycobacterial drug resistance had little effect on the outcome of treatment for infected adults studied by G.W. Thwaites and colleagues at the University of Oxford-Wellcome Trust Clinical Research Unit in Ho Chi Minh City and other institutions in Vietnam, Thailand, and the United Kingdom. The researchers examined 56 Vietnamese tuberculous meningitis patients, confirmed by cerebrospinal fluid culture. Patients coinfected with HIV were significantly more likely to carry mycobacterial populations resistant to streptomycin and isoniazid, according to the study.

However, data showed that neither isoniazid nor streptomycin resistance was associated with increased mortality risks. Microbial genotype and HIV coinfection also failed to impact patient mortality rates. The only clinical variable linked to heightened mortality risk was coma score. This variable independently predicted death during hospitalization.

"Treatment of tuberculous meningitis before the onset of coma saves lives," Thwaites and others wrote. "Resistance to isoniazid and/or streptomycin does not appear to affect outcome." Their full report, "Isoniazid Resistance, Mycobacterial Genotype and Outcome in Vietnamese Adults with Tuberculous Meningitis," was published in the International Journal of Tuberculosis and Lung Disease (2002;6(10):865-871).

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