Gönül ŞENGÖZ, Filiz YILDIRIM, KADRİYE KART YAŞAR, Denef BERZEG, Mehmet BAKAR, Özcan NAZLICAN

Beyin - omurilik sıvısından izole edilen 45 M. tuberculosis suşunun E -test yöntemi ile antitüberküloz ilaçlara duyarlılıkları

Yüzyıllar boyunca toplum sağlığını tehdit eden en önemli hastalıklardan biri olan tüberküloz, günümüzdeki etkili tedavisine rağmen, sorun olmaya devam etmektedir. Laboratuvarımızda beyin-omurilik sıvısından Löwenstein-Jensen besiyerinde üretilen ve M.tuberculosis olarak identifiye edilen 45 suş için E-test yöntemi ile isoniazid, rifampisin, etambutol ve streptomisinin MİK değerleri araştırılmış, MİK90 değerleri sırasıyla 0.016, 0.016, 0.023 ve 0.125 µg/ml olarak saptanmıştır. Bir olguda çok ilaca direnç tespit edilmiştir. Tüberküloz menenjit, klinik olarak hastalığın en ağır formudur, mortalitesi ve sekel kalma olasılığı yüksektir. Dirençli suşlarla karşılaşıldığında tedavi seçenekleri sınırlıdır. Bu çalışma ile, beyin omurilik sıvısından bakterinin izole edildiği her olguda duyarlılık testlerinin uygulanmasının gerekli olduğu, duyarlılık testlerini yapmak için ampirik tedavi başarısızlığını beklemeye fırsat olmayabileceği ve az oranda da olsa çok ilaca dirençli olgularla karşılaşılabileceği vurgulanmak istenmiştir.

Anahtar Kelimeler:

İzoniazid, İlaç direnci, çoklu, bakteriyel, Tüberküloz, çoklu ilaç direnci, Tüberküloz, meningeal, Streptomisin, Rifampin, Etambutol, Beyin omurilik sıvısı, Antitüberküler ajanlar

Susceptibility of 45 M.tuberculosis strains isolated from cerebrospinal fluid to antituberculous drugs by E-test

Tuberculosis is one of the most important diseases threatening public health throughout centuries and, in spite of the existence of an effective treatment, is still a problem. In our laboratory 45 M.tuberculosis strains isolated from cerebrospinal fluid cultured onto Löwenstein-Jensen medium were studied for their MIC values with E-test method for isoniazid, rifampicin, ethambutol and streptomycin. MIC90 values were found as 0.016, 0.016, 0.023 and 0.125 µg/ml, respectively. In only one case multi-drug resistance was present. Tuberculous meningitis is the most serious form of the disease, with high ratio of mortality and sequelae. We propose that in all cases of tuberculous meningitis the susceptibility tests should be performed immediately since there may not be a chance to wait the results of empirical treatment.

Keywords:

Isoniazid, Drug Resistance, Multiple, Bacterial, Tuberculosis, Multidrug-Resistant, Tuberculosis, Meningeal, Streptomycin, Rifampin, Ethambutol, Cerebrospinal Fluid, Antitubercular Agents,

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