Caws M, Thwaites G E, Duy P M, Tho D Q, Lan N T Ngoc, Hoa D V, Chau T T Hong, Huyen M N Thu, Anh P T Hoang, Chau N V V, Chinh T N T, Stepniewska K, Farrar J
Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.
Int J Tuberc Lung Dis. 2007 Feb;11(2):202-8.
Tertiary referral hospitals in southern Vietnam.
Molecular characterisation of multidrug-resistant (MDR) tuberculous meningitis (TBM).
Mycobacterium tuberculosis isolates from the cerebrospinal fluid (CSF) of 198 Vietnamese adults were compared with 237 isolates from patients with pulmonary tuberculosis (PTB) matched for age, sex and residential district. Isolates resistant to isoniazid or rifampicin (RMP) were sequenced in the rpoB and katG genes, inhA promoter and oxyR-ahpC intergenic regions.
While drug resistance rates were lower in the CSF (2.5% MDR) than pulmonary isolates (5.9% MDR), the difference was not significant. The most commonly mutated codons were 531, 526 and 516 in rpoB and 315 in katG. Four novel triple mutants in rpoB were identified.
RMP resistance is a good surrogate marker for MDR-TBM in this setting. However, probes directed against these three codons would have a maximum sensitivity of only 65%. A rapid phenotypic detection test may be more applicable for the diagnosis of MDR-TBM.
越南南部的三级转诊医院。
对耐多药结核性脑膜炎（TBM）进行分子特征分析。
将198例越南成年患者脑脊液（CSF）中的结核分枝杆菌分离株与237例年龄、性别和居住地区匹配的肺结核（PTB）患者的分离株进行比较。对耐异烟肼或利福平（RMP）的分离株进行rpoB和katG基因、inhA启动子及oxyR-ahpC基因间区域的测序。
虽然脑脊液中的耐药率（耐多药率2.5%）低于肺部分离株（耐多药率5.9%），但差异不显著。rpoB中最常见的突变密码子为531、526和516，katG中为315。在rpoB中鉴定出4个新的三联突变体。
在这种情况下，利福平耐药是耐多药结核性脑膜炎的一个良好替代标志物。然而，针对这三个密码子的探针最大灵敏度仅为65%。快速表型检测试验可能更适用于耐多药结核性脑膜炎的诊断。
