AEGiS-15IAC: HIV and multidrug resistant tuberculous meningitis co-infection in children: first case series.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

HIV and multidrug resistant tuberculous meningitis co-infection in children: first case series.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. A10415)

Padayatchi N, Bamber S
Centre for the aids program for research in South Africa, Durban, South Africa

OBJECTIVE: MDR-TBM in children has not been previously described. We describe the clinical presentation, diagnostic and management challenges and outcome of HIV and multidrug resistant tuberculous meningitis (MDR-TBM) co-infection in children.

METHODS: Cultures of 6781 CSF samples were collected between 1996 to 2003, of which 362 yielded Mycobacterium tuberculosis(Mtb). 42 were multidrug resistant (MDR). The hospital records of the 5 children with MDR-TBM were used to obtain clinical data.

RESULTS: There was a history of a TB contact in 2 children only. All the children presented initially with vague signs and symptoms such as diarrhoea, vomiting, low grade pyrexia and impaired consciousness. As the disease progressed there were more localized neurological signs such as convulsions. Four children were HIV positive. The diagnosis of meningitis was made clinically and confirmed on lumbar puncture. In 3 of the 5 children, MDR Mtb was diagnosed posthumously. Of the remaining 2 children, 1 is receiving appropriate TB treatment at a state hospital, has commenced anti-retroviral drugs privately and has returned to school. The second child died despite appropriate TB therapy. Contributors to mortality were co-morbid disease related to other organ involvement.

CONCLUSIONS: The findings suggest that MDR-TB was community acquired. In order to reduce the risk of developing MDR-TB and consequent MDR-TBM, every effort should be made to ensure directly observed therapy and completion of treatment. CSF studies should always include culture and susceptibility testing. There is an urgent need for diagnostic tests with improved sensitivity, not only for sputum susceptibility, but also for CSF. Culture is too slow and insensitive to aid in clinical decision making in MDR-TBM. Diagnosis of TBM should be considered in children with neurologic signs and symptoms and risk factors for TB. Mortality is associated with inappropriate treatment, delays in diagnosis and susceptibility testing. Intrathecal therapy should be explored.

Keywords: AEGIS, Acquired Immunodeficiency Syndrome, HIV Seropositivity, Tuberculosis, Meningeal, Mycobacterium tuberculosis, Communicable Diseases, Directly Observed Therapy, Risk Factors, Child, Humans, diagnosis, therapy

040711
A10415