Drug Resistance Patterns in Tubercular Meningitis patients from North India
Tanish Modi1, Kusum Sharma2, Neeraj Singla3, Tina Sood1
1Government Medical College and Hospital, 2Department of Medical Microbiology, 3Department of Internal Medicine, PGIMER
Objective:
We aim to study the extensiveness of drug resistance in patients of Tubercular Meningitis (TBM) in our population.
Background:
Drug-resistant TBM is a potentially underrecognized entity, and delay in the institution of appropriate therapy may pave the way for development of further drug resistance by facilitating selective growth of resistant bacilli. Due to the paucibacillary nature of CNS-TB, it is difficult to isolate mycobacteria from the CSF. Thus, there is limited data regarding drug susceptibility in TBM.
Design/Methods:
All suspected TBM patients from across North India presenting to the emergency and those hospitalized in our institute were screened and recruited if they fulfilled the inclusion and exclusion criteria. CSF samples were processed by putting up smear for Ziehl-Neelsen staining and inoculation into the LJ culture media (solid culture) and MGIT 960 (liquid culture). Drug susceptibility patterns of MTB isolates from CSF samples were assessed for first and second-line drugs by phenotypic (MGIT 960) liquid culture method.
Results:
Out of 309 CSF samples processed, 11.65% (36/309) were culture positive. MDR-TB was detected in 16.66% (6/36) of isolates. However, the prevalence of Pre-XDR-TB and XDR-TB among isolates was 5.55% (2/36) and 2.77% (1/36), respectively. Fluoroquinolone (FQ) resistance was observed in 16.66% (6/36) isolates. Of the 6 FQ-resistant isolates, 2/6 were Pre-XDR and 4/6 were mono-FQ resistant. Resistance to second-line injectables was observed in 8.33% (3/36) isolates. Mono-resistance to isoniazid was observed in 8.33% (3/36) of isolates.
Conclusions:
The prevalence of MDR in culture positive TBM patients was observed to be high (16.66%) in our study. Fluoroquinolone resistance was observed both in MDR-TB and sensitive TBM. Rapid detection of drug resistance is essential in a clinically relevant time frame for the timely initiation of appropriate treatment and better patient outcomes.