Standard treatment for drug-susceptible TBM during the study period consisted of 12 months of therapy including an intensive 2 month phase of rifampicin, isoniazid, pyrazinamide, an injectable agent (amikacin, kanamycin or streptomycin), and a fluoroquinolone (levofloxacin, moxifloxacin or ofloxacin) as well as dexamethasone and mannitol for management of intracranial hypertension. Patients who did not meet the case definition of TBM by scoring criteria also had a detailed chart review and those without alternative diagnoses and a clinical presentation compatible with TBM were included. based infectious diseases physicians not involved in patient care.
We excluded patients with an alternative diagnosis as determined by chart review from two U.S. Patients admitted for TBM work up between Januand Januwere eligible to be included. There are twenty inpatient beds on the TBM ward and all patients with suspected TBM throughout the country are recommended to be referred to the NCTLD for initial evaluation and inpatient management. The NCTLD campus contains the National Reference Laboratory, three inpatient hospitals and outpatient DOT clinics. Patients receiving treatment for TBM at the National Center for Tuberculosis and Lung Diseases (NCTLD) in Tbilisi, Georgia were included. We utilized a retrospective observational cohort study design. Our goal was to characterize long-term mortality in patients with TBM and determine the impact of drug resistance on morbidity and mortality. To address this question, we conducted a retrospective cohort study at a TBM referral hospital in the country of Georgia, which has a high burden of MDR-TB and a centralized system for collecting data on long-term mortality. Thus, it is critical to establish a more accurate measure of current treatment outcomes in drug-resistant TBM against which future diagnostic and treatment interventions can be measured. bedaquiline, pretomanid, and linezolid) to treat MDR-TB present a tremendous opportunity to improve diagnosis and treatment outcomes in drug-resistant TBM. The advent of sensitive molecular diagnostics such as Xpert MTB/RIF, as well as implementation of new and repurposed drugs (i.e. These limited data show mortality rates among patients treated for drug-resistant TBM ranges from 69–100%. To date there have been only a few studies of patients with drug-resistant TBM from a small number of geographic areas and none from Eastern European countries. However, there are only limited data on the impact of drug-resistance on clinical outcomes among patients with TBM. Historically, clinical outcomes among patients with pulmonary MDR- or XDR-TB have been much worse compared to patients with drug-susceptible disease. The emergence of drug–resistant (DR) TB including multidrug-resistant (MDR) and extensively drug-resistant (XDR) disease have presented major challenges to worldwide TB control. High rates of morbidity and mortality among patients with TBM are due in part to delays in diagnosis and hence prompt initiation of anti-TB treatment, as well as poor CSF penetration of many anti-TB drugs such as rifampin. Persons with TBM also suffer from high rates of long-term neurological sequelae due to disease complications including infarction, vasculitis, and hydrocephalus. Among patients treated for drug susceptible TBM, overall hospital mortality rates are up to 50% and long-term five-year mortality rates of 58%. Tuberculosis meningitis (TBM) is the most lethal manifestation of TB disease. The funders had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript.Ĭompeting interests: The authors have declared that no competing interests exist.
award (E.E) as well as support from the NIH including the Fogarty International Center (D43 TW007124) and NIAID (R03 AI139871, K23AI103044, K23 AI144040, P30AI168386 ). This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.ĭata Availability: All relevant data are within the paper and its Supporting Information files.įunding: This work was supported in part by IDSA and HIVMA through a G.E.R.M. Received: SeptemAccepted: JPublished: June 24, 2022Ĭopyright: © 2022 Evans et al. PLoS ONE 17(6):Įditor: Pere-Joan Cardona, Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Universitat Autònoma de Barcelona, SPAIN (2022) Long term outcomes of patients with tuberculous meningitis: The impact of drug resistance. Citation: Evans EE, Avaliani T, Gujabidze M, Bakuradze T, Kipiani M, Sabanadze S, et al.
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