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SETTING: Tertiary referral hospitals in southern Vietnam. OBJECTIVE: Molecular characterisation of multidrug-resistant (MDR) tuberculous meningitis (TBM). DESIGN: 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. RESULTS: 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. CONCLUSION: 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.

Type

Journal article

Journal

The international journal of tuberculosis and lung disease

Publication Date

02/2007

Volume

11

Pages

202 - 208

Addresses

Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam. mcaws@hotmail.com

Keywords

Sputum, Humans, Mycobacterium tuberculosis, Tuberculosis, Meningeal, Isoniazid, DNA, Bacterial, Antitubercular Agents, Molecular Probes, Logistic Models, Nucleic Acid Amplification Techniques, DNA Mutational Analysis, Drug Resistance, Multiple, Bacterial, Vietnam, Female, Male