Multidrug resistant mycobacterium tuberculosis infections in patients with acquired immunodeficiency syndrome at Siriraj Hospital.

ABSTRACT

Bachground The increase in the prevalence of multidrug-resistant tuberculosis (MDR-TB) has been alarming globally. HIV and Mycobacterium tuberculosis co-infection is not uncommon. The mortality rate of MDR-TB it self is generally high. We describe 21 patients with multidrug-resistant Mycobacterium tuberculosis infection (MDR-TB), who had acquired immunodeficiency syndrome (AIDS). Methods: Information concerning all patients with AIDS and M. tuberculosis co-infection treated at Siriraj Hospital was collected from January 1, 1998, through June 30, 2001 which included clinical presentation, laboratory data, chest x-ray findings, treatment and outcome. Results: Six hundred and forty nine isolates of M. tuberculosis were tested for antimycobacterial susceptibility. 58 isolates (8.9%) were multidrug-resistant. Twenty one patients (36%) had AIDS. Of these, seven patients (33.3%) had primary drug resistant tuberculosis and 15 (66.7%) had secondary drug resistant tuberculosis. The mortality rate of MDR-TB with AIDS was 71.4%. The most common clinical presentations were fever (61.9%), cough (47.6%), and peripheral lymphadenopathy (33.3%). Twenty four percent had pulmonary disease only, 52% had both pulmonary and extrapulmonary diseases. The mean CD4 lymphocyte count was 38.8+45.77 cells/?L. Thirty three percent of the isolates were resistant to isoniazid and rifampicin only, 43% were resistant to 3 drugs and 24% to 4 drugs. Conclusion: The prevalence of MDR-TB was 8.9% ( 58 of 649 cases) in Siriraj Hospital from January 1, 1998 through June 30, 2001. Twenty-one of these patients (36%) had AIDS. Patients with MDR-TB were more likely to have disseminated disease and low CD4 lymphocyte counts. The mortality rate was high. All isolates of M. tuberculosis should be tested for antimycobacterial susceptibility to guide treatment and improve the outcome.