Isoniazid-Resistant Tuberculous Meningitis, United States, 1993–2005

DOI: 10.3201/eid1703.101715
Suggested citation for this article: Vinnard C, Winston CA, Wileyto EP, MacGregor RR, Bisson GP. Isonzaid-resistant tuberculous meningitis, United States, 1993–2005. Emerg Infect Dis. 2011 Mar; [Epub ahead of print]
Isoniazid-Resistant Tuberculous Meningitis, United States, 1993–2005
Christopher Vinnard, Carla A. Winston, E. Paul Wileyto, Rob Roy MacGregor, and Gregory P. Bisson



Author affiliations: University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA (C. Vinnard, E.P. Wileyto, R.R. MacGregor, G.P. Bisson); and Centers for Disease Control and Prevention, Atlanta, Georgia, USA (C.A. Winston)


To determine patient characteristics associated with isoniazid resistance in cases of tuberculous meningitis, we conducted a cross-sectional study by using data from the US National Tuberculosis Surveillance System during 1993–2005. Foreign-born patients were more likely to be infected with an isoniazid-resistant strain compared with patients 25–34 years of age.

The mortality rate for tuberculous meningitis (TBM) is higher than other forms of tuberculosis (TB), and survivors are often left with severe neurologic disability (1–3). We have recently shown that infection with isoniazid-resistant (rifampin-susceptible) Mycobacterium tuberculosis was associated with a 2-fold increase in the odds of death during therapy among patients with TBM who had positive cerebrospinal fluid (CSF) cultures, compared with patients with isoniazid-susceptible cases (4).

When patients have a history of TB, clinicians may consider treatment history and drug susceptibilities in choosing empiric therapy (5). In contrast, little guidance is available to the clinician in the selection of an empiric regimen for patients without a history of treatment. Given that host and pathogen genotypes have been found to jointly influence the propensity of M. tuberculosis to cause meningeal infection, the epidemiology of isoniazid-resistant TBM may be different for meningeal and nonmeningeal forms of TB (6). We...

full-text (7 pages):
http://www.cdc.gov/eid/content/17/3/pdfs/10-1715.pdf?source=govdelivery