PEDIATRICS Vol. 42 No. 6 December 1968, pp. 969-975
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TUBERCULOUS MENINGITIS DUE TO PRIMARY DRUGRESISTANT MYCOBACTERIUM TUBERCULOSIS HOMINIS

Richard J. Bonforte M.D.1, Charles M. Karpas M.D.1, Irwin Gribetz M.D.1, and Stefan Shanzer M.D.1

1 Departments of Pediatrics and Neurology, The Mount Sinai Hospital and The Mount Sinai School of Medicine, and the Departments of Pathology and Medicine, Beekman-Downtown Hospital, New York City

Fatal drug-resistant tuberculous meningitis developed in a 6-year-old boy who had received measles vaccine. The infecting organism was Mycobacterium tuberculosis hominis resistant to isoniazid, streptomycin, para-amino-salicylic acid, and ethionamide. Clinically, the course of disease in children infected with INH-resistant strains of tubercle bacilli does not differ appreciably from the course in children harboring INH-sensitive organisms. Therefore, potentially fatal complications such as miliary disease and meningitis can develop in both instances. Up to now, however, such complications have been uncommonly associated with drug-resistant tuberculosis. The therapeutic and epidemiologic importance of determining the pattern of drug sensitivity of the tubercle bacillus, especially a strain resistant to multiple drugs, is discussed in the light of this case report. Speculation is also made as to the relation of the child's illness to his prior inoculation with measles vaccine.

Submitted on January 10, 1968
Accepted on June 12, 1968