Absence of an association between Mycobacterium tuberculosis genotype and clinical features in children with tuberculous meningitis
Date
2007
Authors
Maree F.
Hesseling A.C.
Schaaf H.S.
Marais B.J.
Beyers N.
Van Helden P.
Warren R.M.
Schoeman J.F.
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Abstract
OBJECTIVES: Animal studies point to increased virulence of certain mycobacterial strains, notably those of the Beijing genotype. There are limited data on mycobacterial genotypic diversity in children with tuberculous meningitis (TBM). We investigated mycobacterial genotypic diversity in children with TBM and analyzed the relationship among genotype, clinical presentation and outcome. PATIENTS AND METHODS: Data were extracted from an ongoing prospective study on children with confirmed TBM from 1992 through 2003 at a referral hospital in the Western Cape Province, South Africa. Mycobacterial isolates were genotyped by standardized restriction fragment length polymorphism methodology. Clinical data at diagnosis, inflammatory progression during the first month of antituberculosis therapy and neurologic outcomes after 6 months of therapy were analyzed according to the principal genetic group of the strain and the presence of the Beijing strain, respectively. RESULTS: Fifty-nine children were included (median age at diagnosis, 23 months); 37 presented with stage II and 22 with stage III presented with TBM. At completion of antituberculosis therapy, 6 children were neurologically normal, 22 were moderately neurologically impaired, 23 were severely neurologically impaired and 6 children died; detailed outcomes were not available in 2 children. All 3 principal genetic groups were represented (group 1, 27.1%; group 2, 59.3%; group 3, 13.6%); the most prevalent strains were of the Beijing genotype (family 29; 25.4%), followed by family 28 (10.2%) and family 11 (8.5%). Predictors of poor neurologic outcome included advanced disease at diagnosis and male gender. There was no association between the principal genetic group of the strain or the presence of the Beijing genotype, and clinical presentation or outcome. CONCLUSIONS: We found no association between Mycobacterium tuberculosis genotypes and clinical presentation or outcome. © 2007 Lippincott Williams & Wilkins, Inc.
Description
Keywords
acetazolamide, ethionamide, furosemide, isoniazid, prednisone, pyrazinamide, rifampicin, adolescent, article, bacterial strain, bacterium isolate, brain ventricle peritoneum shunt, cause of death, child, clinical feature, communicating hydrocephalus, controlled study, female, genetic variability, genotype, human, hydrocephalus, infant, major clinical study, male, Mycobacterium tuberculosis, neurologic disease, priority journal, prospective study, restriction fragment length polymorphism, sex difference, South Africa, treatment outcome, tuberculous meningitis, Adolescent, Antibiotics, Antitubercular, Antitubercular Agents, Child, Child, Preschool, Ethionamide, Female, Genotype, Humans, Infant, Isoniazid, Male, Microbial Sensitivity Tests, Mycobacterium tuberculosis, Pyrazinamide, Retrospective Studies, Rifampin, Treatment Outcome, Tuberculosis, Meningeal
Citation
Pediatric Infectious Disease Journal
26
1
26
1