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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Impact of drug resistance on clinical outcome in children with tuberculous meningitis
Pediatric Infectious Disease Journal, Volume 31, No. 7, Year 2012
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Description
Background: Tuberculous meningitis (TBM) is associated with delayed diagnosis and poor outcome in children. This study investigated the impact of drug resistance on clinical outcome in children with TBM. Methods: All children (0-13 years) were included if admitted to Tygerberg Children's Hospital, Cape Town, South Africa, from January 2003 to April 2009 with a diagnosis of either confirmed TBM, or probable TBM with mycobacterial isolation from a site other than cerebrospinal fluid. Mycobacterial samples underwent drug susceptibility testing to rifampin and isoniazid. Children were treated with isoniazid, rifampin, pyrazinamide and ethionamide according to local guidelines. Results: One hundred twenty-three children were included; 13% (16 of 123) had any form of drug resistance, and 4% (5 of 123) had multidrug-resistant tuberculosis. Time from start of symptoms to appropriate treatment was longer in children with any drug resistance (median: 31 days versus 9 days; P = 0.001). In multivariable analysis, young age (P = 0.013) and multidrug-resistant tuberculosis (adjusted odds ratio: 12.4 [95% confidence interval: 1.17-132.3]; P = 0.037) remained risk factors for unfavorable outcome, and multidrug-resistant tuberculosis remained a risk for death (adjusted odds ratio: 63.9 [95% confidence interval: 4.84-843.2]; P = 0.002). We did not detect any difference in outcome between those with isolates resistant to only isoniazid and those with fully susceptible strains (adjusted odds ratio: 0.22 [confidence interval: 0.03-1.87]; P = 0.17). Conclusion: Multidrug-resistant TBM in children has poor clinical outcome and is associated with death. We did not find any difference in the outcomes between children with isoniazid monoresistant TBM and those with drug-susceptible TBM. One explanation could be the local treatment regimen. Further investigation of this regimen is indicated. © 2012 by Lippincott Williams ∧ Wilkins.
Authors & Co-Authors
Seddon, James Alexander
Unknown Affiliation
Visser, Douwe Hendrik
Unknown Affiliation
Bartens, Margaux
Unknown Affiliation
Jordaan, Annemarie M.
Unknown Affiliation
Victor, Thomas Calldo
Unknown Affiliation
Van Furth, A. M.
Unknown Affiliation
Schoeman, Johan Feuth
Unknown Affiliation
Schaaf, Hendrik Simon
Unknown Affiliation
Statistics
Citations: 48
Authors: 8
Affiliations: 5
Identifiers
Doi:
10.1097/INF.0b013e318253acf8
ISSN:
08913668
e-ISSN:
15320987
Research Areas
Health System And Policy
Maternal And Child Health
Study Design
Case-Control Study
Study Locations
South Africa