Sofia M, Maniscalco M, Honoré N, Molino A, Mormile M, Heym B, Cole S T
Department of Respiratory Disease, University of Naples Federico II, Italy.
Int J Tuberc Lung Dis. 2001 Jun;5(6):551-8.
Rapidly progressive multidrug-resistant tuberculosis (MDR-TB) is well documented in human immunodeficiency virus (HIV) positive subjects, but it is not fully recognised in HIV-negative subjects in the familial environment. We report three cases of MDR-TB in three young HIV-negative subjects from the same family. All the patients showed signs of meningitis during the course of their disease, and in two cases a resistant strain of Mycobacterium tuberculosis was isolated in cerebrospinal fluid. Two of the three subjects died from neurological complications; the other was successful treated utilising both systemic and intrathecal therapy for tuberculous meningitis. By a retrospective analysis of DNA obtained from Lowenstein-Jensen cultures, the strains were confirmed as M. tuberculosis resistant to rifampicin and isoniazid, and were closely related in the two cases where specimens were available for analysis. The resistance was acquired in two patients initially infected with a susceptible strain; in the other patient, the resistance was present on the first sensitivity test for which results were available. This report demonstrates the high risk of fatality from MDR-TB for HIV-negative subjects in the absence of reliable early diagnostic and preventive tools. It also reinforces the concept that genetic susceptibility to M. tuberculosis may be an important factor in the clinical presentation and outcome of MDR-TB.
快速进展性耐多药结核病（MDR-TB）在人类免疫缺陷病毒（HIV）阳性患者中已有充分记录，但在家庭环境中的HIV阴性患者中尚未得到充分认识。我们报告了来自同一家庭的三名年轻HIV阴性患者发生MDR-TB的病例。所有患者在病程中均出现脑膜炎症状，其中两例脑脊液中分离出耐结核分枝杆菌菌株。三名患者中有两名死于神经系统并发症；另一名患者采用全身和鞘内治疗结核性脑膜炎获得成功。通过对从罗-琴培养基培养物中获得的DNA进行回顾性分析，证实这些菌株为耐利福平及异烟肼的结核分枝杆菌，且在可用于分析的两例病例中密切相关。两名最初感染敏感菌株的患者获得了耐药性；另一名患者在首次有结果的药敏试验中就已存在耐药性。本报告表明，在缺乏可靠的早期诊断和预防工具的情况下，HIV阴性患者发生MDR-TB有很高的死亡风险。它还强化了这样一种观念，即对结核分枝杆菌的遗传易感性可能是MDR-TB临床表现和结局的一个重要因素。
