Foreign-born patients are more likely to have a form of tuberculosis that resists a common drug used in treatment
Research Activities, July 2011, No. 371
Tuberculous meningitis (TBM), an infection of the membranes that cover the brain and spinal cord, is a life-threatening disease that can also cause severe neurological impairment in survivors. Along with other drugs, isoniazid is commonly used to treat patients with tuberculosis (TB). However, a new study finds that foreign-born patients with TBM are more likely to be infected with a TB strain that resists isoniazid's effects.
Researchers from the University of Pennsylvania School of Medicine used 1993 to 2005 data from the U.S. National Tuberculosis Surveillance System and identified 1,649 patients diagnosed with TB. These patients had no prior history of TB, had cerebrospinal fluid cultures that were positive for TBM, and underwent drug-susceptibility testing. Of the 1,649 patients, 8 percent were infected with a TB strain resistant to isoniazid.
After comparing characteristics of patients whose TB was resistant to isoniazid with patients whose TB could be treated with the drug, the authors found that foreign-born patients were more than twice as likely than U.S.-born patients to have isoniazid-resistant TB (odds ratio 2.53). However, characteristics such as HIV status, race, and residence in a long-term-care facility were not associated with TB that was resistant to isoniazid. The authors recommend that researchers conduct studies to help clinicians precisely determine which TB therapies will improve outcomes for patients with TBM. This study was funded in part by the Agency for Healthcare Research and Quality (HS10399).
See "Isoniazid-resistant tuberculosis meningitis, United States, 1993-2005," by Christopher Vinnard, M.D., Carla A. Winston, Ph.D., M.A., E. Paul Wileyto, Ph.D., and others in the March 2011 Emerging Infectious Diseases 17(3), pp. e1-e7.