Multi-drug-resistant tuberculous meningitis in pediatric age group: Experience at the children's hospital,Lahore - Pakistan

Background: past decade has seen an increase in cases of tuberculous meningitis (tbm) and multi-drug-resistance in such cases. mortality is increased manifolds in presence of multi-drug-resistant tuberculous meningitis (mdr-tbm). objective: the present study was planned to determine the frequency of mdr-tbm,in hospitalized children and to analyze drug sensitivity pattern in all culture positive isolates from cerebrospinal fluid (csf). methods: sixty-five cerebrospinal fluid (csf) samples from children clinically suspected of having tbm were collected from january 2008 to december 2008 and processed for detection of mycobacterium tuberculosis by ziehl neelsen (zn) staining and bactec 12 b medium culture. antimicrobial susceptibility was performed on all culture positive isolates by bactec 460 tb system. results: in csf of 65 clinically suspected tbm cases biochemical findings consistent with the diagnosis were documented in 50.8% and pleocytosis was present in 78.3%. zn staining only identified 2 cases of tbm (3.1%). ten cases (15.4%) could be diagnosed as definitive tbm based on bactec culture. of all isolates tested for drug sensitivity 8 (80%) were sensitive to all four first line antituberculous drugs while 2 (20%) isolates were resistant to ≥3 drugs. inappropriate antituberculous therapy used previously and malnutrition were detected in mdr-tbm patients. conclusion: since the prevalence of mdr-tbm is very high,we conclude that all csf samples should be subjected to sensitivity testing in regional tuberculosis centers to diagnose it at an early stage,determine its sensitivity pattern in view of its very high mortality and to prevent further transmission.