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Drug-resistant M. tuberculosis more likely in foreign-born patients with TBM
Vinnard C. Emerg Infect Dis. 2011; doi:10.3201/eid1703.101715.
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Patients with tuberculosis meningitis born outside of the US were more likely to be infected with an isoniazid-resistant strain of Mycobacterium tuberculosis when compared with US-born patients, according to new findings from a cross-sectional study.
Christopher Vinnard, MD, of the division of infectious diseases at the University of Pennsylvania School of Medicine, and colleagues pooled data on tuberculosis meningitis cases between 1993 and 2005 from the US National Tuberculosis Surveillance System and assessed patient characteristics associated with isoniazid resistance.
Patients with a previous diagnosis of TB or with multidrug-resistant disease were excluded from the study.
Of 1,649 patients with tuberculosis meningitis, 14% were infected with isolates resistant to isoniazid, rifampin, ethambutol, pyrazinamide, or streptomycin — 8% were infected with at least one isoniazid-resistant isolate. Isoniazid-resistance was uncommon in patients aged older than 64 years.
Foreign birth was the only characteristic independently associated with isoniazid-resistance on initial testing (OR=2.53; 95% CI, 1.66–3.88). Twenty of the 69 foreign-born patients with isoniazid-resistant disease resided in Mexico; seven of the nine countries with 2 or more cases of isoniazid-resistant disease were located in Asia. Although 53% of patients were HIV-positive, no association was observed between HIV and isoniazid resistance (OR=1.10; 95% CI, 0.70-3.65).
“Prospective studies are needed to determine whether individual patient characteristics can guide the selection of tuberculosis meningitis therapies and lead to an improvement in clinical outcomes,” the researchers wrote.
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