Tuberculous Meningitis: The Microbiological Laboratory Diagnosis and Its Drug Sensitivity Patterns
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Background: Tuberculosis continues one of the major challenges to global health. Mycobacterium tuberculosis complex can affect any organ other than the lung parenchyma, include central nervous system. The mortality rate of tuberculous meningitis (TBM) are high worldwide with up to half of survivors suffering irreversible sequelae. Diagnosis of TBM is difficult due to paucibacillary, various clinical manifestation, and invasive procedure to appropriate specimens. Objective: The objectiveis to study the positivity rate of microbiological laboratory diagnosis and its drug sensitivity patterns of TBM patients in Dr. Soetomo Hospital Surabaya during October 2015 until September 2016. Methods: Specimens were cerebrospinal fluids. Identification and drug anti TB sensitivity test were done by BACTEC MGIT 960 system in Clinical Microbiology Laboratory Dr. Soetomo Hospital Surabaya. Result: Most patients with TBM were women (54.29%). Based on age groups, most dominant was adult population (65.71%). Proportion percentage of positive M. tuberculosis complex among 180 specimens were 19.44%. First line anti TB drug sensitivity pattern of 35 isolates were 1 monoresistant, 1 poly-resistant, no multiple drug resistant (MDR), and 33 pan-susceptible. Conclusion: Positivity rate of Mycobacterium tuberculosis complex laboratory diagnosis from TBM suspect patients were low. There was no MDR TB in this study, but mono-resistant and poly-resistant. Microbiological diagnosis was important to give information of active disease and drug sensitivity pattern. Resistance to first line anti TB drugs is alarming to properly manage TBM patients.
World Health Organization. Global tuberculosis report. Geneva, Switzerland: WHO Press; 2012.
World Health Organization. Global tuberculosis report. Geneva, Switzerland: WHO Press; 2014.
World Health Organization. Global tuberculosis report. Geneva, Switzerland: WHO Press; 2015.
CDC. Extrapulmonary tuberculosis cases and percentages by site of disease: reporting areas. Atlanta, GA: Centers for Disease Control and Prevention; 2005.
Krishnan N, Robertson BD, Thwaites G. The mechanisms and consequences of the extra-pulmonary dissemination of Mycobacterium tuberculosis. Tuberculosis (Edinb) 2010; 90: 361–66.
Rich AR, McCordock HA. The pathogenesis of tuberculous meningitis. Bull. Johns Hopkins Hosp. 1933; 52:5–37.
Katti MK. Pathogenesis, diagnosis, treatment, and outcome aspects of cerebral tuberculosis. Med Sci Monit 2004;10:RA215-29.
Thakur R, Goyal R, Sarma S. Laboratory Diagnosis of Tuberculous Meningitis – Is There a Scope for Further Improvement?. Journal of Laboratory Physicians 2010;2: Issue-1.
Vinnard C, Macgregor RR. Tuberculous Meningitis in HIV-Infected Individuals. Curr HIV/AIDS Rep. 2009 August; 6(3): 139–145.
Marx GE, Chan ED. Review Article Tuberculous Meningitis: Diagnosis and Treatment Overview. Hindawi Publishing Corporation Tuberculosis Research and Treatment 2011:9.
Kementerian Kesehatan RI. Pedoman nasional pengendalian tuberculosis. Jakarta: Kemenkes RI; 2014
Kementerian Kesehatan RI. Petunjuk pelaksanaan pemeriksaan tuberculosis menggunakan alat GeneXpert. Jakarta: Kemenkes RI; 2015.
Murthy JMK. Tuberculous meningitis: The challenges. Neurology India Sep-Oct 2010; 58(5).
Global laboratory initiative. Mycobacteriology Laboratory Manual. First edition: GLI; 2014.
Vinnard C, Winston CA, Wileyto EP, Macgregor RR, Bisson GP. Isoniazid resistance and death in patients with tuberculous meningitis: retrospective cohort study. BMJ. 2010;341:c4451.
Jha SK, Garg RK, Jain A, Malhotra HS, Verma R, Sharma PK. Definite (microbiologically confirmed) tuberculous meningitis: predictors and prognostic impact. Infection 2015; 43 (6):639–645.
Chiang SS, Khan FA, Milstein MMB, Tolman AW, Benedetti A, Starke JR, Becerra MC. Treatment outcomes of childhood tuberculous meningitis: a systematic review and meta-analysis. Lancet Infect Dis 2014; 14: 947–57.
Torok ME. Tuberculous meningitis: advances in diagnosis and treatment. 2015. British Medical Bulletin, 2015, 113:117–131.
Ho J, Marais BJ, Gilbert GL, Ralph AP. Diagnosing tuberculous meningitis – have we made any progress?.Tropical Medicine and International Health 2013;18: (6) 783–793.
Katti MK. Pathogenesis, diagnosis, treatment, and outcome aspects of cerebral tuberculosis. Med Sci Monit. 2004; 10: RA215-29.
Thwaites GE, Chau TTH & Farrar J (2004b) Improving the bacteriological diagnosis of tuberculous meningitis. Journal of Clinical Microbiology 42, 378–379.
Erdem H, Engin DO, Elaldi N, et al. The microbiological diagnosis of tuberculous meningitis of Haydarpasa-1 study. Clinical Microbiology and InfectionVolume 20, Issue 10, October 2014, Pages O600O608.
Ducomble T, Tolksdorf K, Karagiannis I, Hauer B, Brodhun B, Haas W, Fiebig L. The burden of extrapulmonary and meningitis tuberculosis: an investigation of national surveillance data, Germany, 2002 to 2009. Surveillance and outbreak reports 2012. www. eurosurveillance.org
De Souza CH, Yamane A, Pandini JC, Ceretta LB, Ferraz F, da Luz GD, Simoes PW. Incidence of tuberculous meningitis in the State of Santa Catarina, Brazil. Revista da Sociedade Brasileira de Medicina Tropical 2014; 47(4): 483–489.
Masfiyah, Bintoro AC, Hadi P. Gambaran Definitif Meningitis Tuberkulosa di RSUP dr. Kariadi Semarang Studi Deskriptif pada pasien dewasa dengan menggunakan real time PCR dengan target amplifikasi pada IS6110 Mycobacterium tuberculosis complex. Sains Medika, Vol. 5, No. 2, Juli – Desember 2013: 62–67.
Wang T, Feng GD, Pang Y, Liu JY, Zhou Y, Yang YN, Dail W, Zhang L, Li Q, Gao Y, Chen P, Zhan LP, Marais BJ, Zhao YL, Zhao G. High rate of drug resistance among tuberculous meningitis cases in Shaanxi province, China. Scientificreports 2016.
Parwati I, Alisjahbana B, Apriani L, Soetikno RD, Ottenhoff TH, van der Zanden AGM, van der Meer J, van Soolingen D, van Crevel R. Mycobacterium tuberculosis Beijing genotype is an independent risk factor for tuberculosis treatment failure in Indonesia. J Infect Dis (2010) 201 (4): 553–557.
Senbayrak S, Ozkutuk N, Erdem H, Johansen IS et al. Antituberculosis drug resistance patterns in adults with tuberculous meningitis: results of haydarpasa-iv study. Ann Clin Microbiol Antimicrob 2015; 14: 47.
Thwaites GE, Lan NT, Dung NH, Quy HT, Oanh DT, Thoa NT, 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.
Makeshkumar V, Madhavan R, Narayanan S. Prevalence of drug resistance in Mycobacterium tuberculosis in a teaching hospital of Kanchipuram district, Tamilnadu, South India. American journal of microbiological research (2014); 2 (1): 35–40.
Bahr NC, Marais S, Caws M, van Crevel R, Wilkinson RJ, Tyagi JS, Thwaites GE, Boulware DR.GeneXpert MTB/Rif to Diagnose Tuberculous Meningitis: Perhaps the First Test but not the Last. Clinical Infectious Diseases 2016.
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