Primary Extensively Drug-Resistant Tuberculosis Meningitis:One Case Report and Literature Review_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

TangShufu ¹ , WangTao ¹ ,  ZhangJianyong ¹ ,  ChenXuerong ² , ChenLing ¹

1. Department of Respiratory Second Division, The Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, 563000, China;
2. ;

Corresponding?author：

ZhangJianyong, Email: zjy9453@sina.com; ChenXuerong, Email: chenxuerong0422@tom.com

Keywords：

Tuberculosis meningitis; Drug resistance; Extensively drug resistance

DOI：

10.7507/1671-6205.2016081

Video：

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Objective To investigate the clinical manifestations,diagnosis and treatment of extensively drug-resistant tuberculosis (XDR-TB)meningitis. Methods One case of primary tuberculousis meningitis infected with multidrug-resistant mycobacteria was analyzed retrospectively.Relevant literatures were also reviewed by retrieving information through Wanfang Database and Pubmed using key words "multiple drug resistant tuberculosis meningitis","MDR tuberculosis meningitis","multiple drug resistant TBM","mul-drug resistant tuberculous meningitis","extensively drug resistant tuberculosis meningitis","XDR TBM","extensively drug resistant TBM" both in Chinese and English. Results A 24-year-old male patient,complained of headache,vomiting for 5 days,aggravated with mental abnormalities for 10 hours,with no history of pulmonary tuberculosis,was hospitalized in the Affiliated Hospital of Zunyi Medical College.The chest plain film was normal.Craniocerebral CT scan showed mild-hydrocephalus and cisterna ambiens stenosis.The patient died after undergoing anti-TB treatments with isoniazid(INH)0.3g iv qd,INH 0.3g po qd,rifampicin(RFP)0.45g qd,pyrazinamide(PZA)1.5g qd,ethambutol(EMB)0.75g qd,and dexamethasone(DEX)15mg qd.He was diagnosed as XDR-TB meningitis(as drug-resistant to isoniazid,rifampicin,streptomycin,ciprofloxacin,paminosalicylic acid,kanamycin,and protionamide ).Mycobacteria tuberculosis was isolated from his cerebrospinal fluid after 3 months.Five cases in 4 literatures were retrieved through Wanfang database and Pubmed among which 2 cases were initial treated,3 cases was unknown about initial treatment or re-treatment. Conclusions XDR-TB meningitis is rare in clinical practice with serious condition,rapid progress and high mortality rate.It is necessary to acquire drug susceptibility test results as soon as possible and adjust treatments according different conditions.A molecular drug susceptibility test may be helpful in the future.

Citation： TangShufu, WangTao, ZhangJianyong, ChenXuerong, ChenLing. Primary Extensively Drug-Resistant Tuberculosis Meningitis:One Case Report and Literature Review. Chinese Journal of Respiratory and Critical Care Medicine, 2016, 15(4): 344-347. doi: 10.7507/1671-6205.2016081 Copy

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2.	Alsleben N,Garcia-Prats AJ,Hesseling AC,et al.Successful treatment of a child with extensively drug-resistant tuberculous meningitis.J Pediatric Infect Dis Soc,2015,4:e41-e44.
3.	Liao PW,Chiang TR,Lee MC,et al.Tuberculosis with meningitis,myeloradiculitis,arachnoiditis and hydrocephalus:a case report.Acta Neurol Taiwan,2010,19:189-193.
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7.	張金福, 陳輝,謝汝明,等.結核性腦膜炎的MRI和CT影像學表現及其比較.中國防癆雜志,2003,25:149-152.
8.	Maclean KA,Becker AK,Chang SD,et al.Extrapulmonary ruberculosis:imaging features beyond the chest.Can Assoc Radiol J,2013,64:319-324.
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10.	陳禹, 冀澍雨,李桂琴.應用含異煙肼、利福平化療方案成功治療耐多藥結核性腦膜炎1例.中國防癆雜志,2013,35:85-86.
11.	唐神結, 許紹發,李亮,主編.耐藥結核學.北京:人民衛生出版社,2014,292-293.

1. Flavell S,Eder M,Beaton RK,et al.Extensively drug resistant tuberculosis in a HIV-infected patient in a UK hospital.Int J STD AIDS,2013,24:63-66.
2. Alsleben N,Garcia-Prats AJ,Hesseling AC,et al.Successful treatment of a child with extensively drug-resistant tuberculous meningitis.J Pediatric Infect Dis Soc,2015,4:e41-e44.
3. Liao PW,Chiang TR,Lee MC,et al.Tuberculosis with meningitis,myeloradiculitis,arachnoiditis and hydrocephalus:a case report.Acta Neurol Taiwan,2010,19:189-193.
4. Pehlivanoglu F,Yasar KK,Sengoz G.Tuberculous meningitis in adults:a review of 160 cases.Scientific World J,2012,2012:169028.
5. Guleria R,Kaviha.Central nervous system tuberculosis.Indian J Tuberc, 2014,61:195-199.
6. 胡忠義. 結核病耐藥性檢測技術進展及存在的問題和對策.中國防癆雜志,2013,35:865-867.
7. 張金福, 陳輝,謝汝明,等.結核性腦膜炎的MRI和CT影像學表現及其比較.中國防癆雜志,2003,25:149-152.
8. Maclean KA,Becker AK,Chang SD,et al.Extrapulmonary ruberculosis:imaging features beyond the chest.Can Assoc Radiol J,2013,64:319-324.
9. World Health Organization.Companion handbook to the WHO guidelines for the programmatic management of drug-resistant tuberculosis.WHO/HTM/TB/2014.11.Geneva:World Health Organization,2014.
10. 陳禹, 冀澍雨,李桂琴.應用含異煙肼、利福平化療方案成功治療耐多藥結核性腦膜炎1例.中國防癆雜志,2013,35:85-86.
11. 唐神結, 許紹發,李亮,主編.耐藥結核學.北京:人民衛生出版社,2014,292-293.

Chinese Journal of Respiratory and Critical Care Medicine

Primary Extensively Drug-Resistant Tuberculosis Meningitis:One Case Report and Literature Review

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